The Plan Year begins August 1, 2012 and ends July 31, 2013 TABLE OF CONTENTS

Transcription

1 Cabarrus County Schools is offering all full-time employees a comprehensive Cafeteria Benefi ts Plan. The Cafeteria Benefi ts Plan is being arranged by Mark III Brokerage, an employee benefi ts fi rm that has worked in the public sector since The Cafeteria Benefi ts Plan allows you to pay for certain insurance premiums, child care, and unreimbursed medical expenses before taxes are taken out of your paycheck. Paying for these benefits in this method reduces your taxes and increases your take home pay. The Plan Year begins August 1, 2012 and ends July 31, 2013 TABLE OF CONTENTS PRE-TAX BENEFITS Flexible Benefi t Administrators Health Care Spending Account...Page 2 Flexible Benefi t Administrators Dependent Care Spending Account...Page 14 Ameritas Dental Plan...Page 20 Community Eye Care Vision Plan...Page 24 Allstate Benefi ts Cancer Plan...Page 26 Afl ac Personal Accident Indemnity Plan...Page 40 Investment & Retirement Accounts...Page 47 AFTER-TAX BENEFITS AUL Short Term Disability Plan...Page 48 Continental American Insurance Company Group Critical Illness Plan...Page 55 Lincoln Financial Term Life Plan...Page 66 Texas Life Whole Life Plan...Page 74 DIRECT- BILL BENEFIT Liberty Mutual Auto & HomeOwners Plan... Page 77 Continuation of Benefi ts...page 79 Phone Directory...Page 81 This booklet highlights the benefits offered through your Employer for the current plan year. This is neither an Insurance Contract nor a Summary Plan Description and only the actual policy provisions will prevail. All information in this booklet including premiums are subject to change. All policy descriptions are for informational purposes only. Page 1

2 Flexible Benefit Administrators Health Care Spending Account Plan Year: August 1, July 31, 2013 Healthcare Flexible Spending Account Maximum: $2, Healthcare Flexible Spending Account Minimum: $250 Waiting Period: First day of the month following your hire date Run Off Period: 60 days following the end of the plan year to file for services rendered during the plan year. FLEXIBLE BENEFIT PLAN: THE BETTER YOU PLAN, THE MORE YOU SAVE! It s more than a slogan. The Flexible Benefi t Plan is a real solution to issues facing all of us. Simply stated, by taking advantage of tax laws, the Flexible Benefi t Plan works with your benefi ts to save you money. Your insurance programs are designed to help you and your family become fi nancially secure as well as to protect you against the high cost of medical care including catastrophic events. However, almost everyone has a number of necessary, predictable expenses that are not covered by your insurance programs. The Flexible Benefi t Plan will help you pay for these predictable expenses. The Flexible Benefi t Plan offers a unique way to help pay for some of your health care expenses and dependent care expenses. The key to the Flexible Benefi t Plan is that your eligible expenses are paid for with Tax Free Dollars. You will not pay any federal, state or social security taxes on funds placed in the Plan. You will save between, approximately, $27.65 and $37.65 on every $100 you place in the Plan. The amount of your savings will depend on your federal tax bracket. Using the Flexible Benefi t Plan can save you a signifi cant amount of money each year, however, it is important that you understand how the Plan works and how you can make the most of the advantages the Flexible Benefi t Plan offers. This handbook will help you understand the Flexible Benefi t Plan. The handbook covers how the Plan works, describes the categories of the Plan, explains the rules governing the Plan, the reimbursement process and how you can elect to participate in the Flexible Benefi t Plan. Prior to electing to participate in the Flexible Benefi t Plan, it is important that you read and understand the Rules and Regulations section of this handbook. After you read this material, if you have any questions please feel free to contact Flexible Benefit Administrators, Inc. at or FLEX NOTE: FLEX is authorized by Section 125 of the Internal Revenue Code Page 2

3 HEALTH CARE REIMBURSEMENT ACCOUNT The Health Care Reimbursement Account allows you to pay for your uninsured medical expenses with pre-tax dollars. With this account, you can pay for your out of pocket medical expenses for yourself, your spouse and all of your dependents for medical services that are incurred during your Plan Year. The minimum you may place in your account is $250. The maximum you may place in this account for the Plan Year is $2,500. EXAMPLES OF ELIGIBLE HEALTH CARE EXPENSES: FEES/CO-PAYS/ DEDUCTIBLES: Acupuncture Prescription Eye glasses/ Physician Ambulance hire Contact lenses Psychologist Anesthetist Psychiatrist Erectile dysfunction Chiropractor Hospital medication Dental Fees Laboratory Sterilization Fee Diagnostic Nursing Surgery Eye Exams Obstetrician X-Rays Laser Eye Surgery Wheel Chair OTHER ELIGIBLE EXPENSES: Prescription drugs Diabetic supplies Artifi cial limbs & breasts Routine Physicals (only if reconstructive) Condoms Birth control pills, patches Dentures (e.g. Norplant) Oxygen Orthopedic shoes/inserts Physical Therapy Incontinence supplies Fertility Treatments Carpal tunnel wrist supports Hearing aids and batteries Vaccinations & Immunizations Reading glasses Elastic hose Medical equipment (medically prescribed) Pedialyte for dehydration Contact lens supplies Nicotine gum/patches Therapeutic care for drug Take-home screening kits (HIV, and alcohol addiction colon cancer) At home pregnancy test kits Smoking cessation programs and prescribed drugs designed to alleviate nicotine withdrawal Mileage, parking and tolls ( you may be reimbursed $.23* a mile plus parking and tolls when medical reasons make it necessary to travel) Tuition fees for medical care (if the college furnishes a breakdown of medical charges) Orthodontic expenses (not for cosmetic purposes) ORTHODONTIC TREATMENT IS REIMBURSED ACCORDING TO YOUR PAY- MENT PLAN WITH THE ORTHODONTIST. FOR EXAMPLE: If your payment plan is set up to pay $100 a month for the orthodontic treatment, you can be reimbursed $100 a month for the payments that become due during the Plan Year. The above list is compiled from IRS publication 502. If you are unsure that your expected medical expense will be eligible under tax code regulations, please call Flexible Benefit Administrators at or FLEX before making your election for the Plan Year. IRS publication 502 can be ordered by calling the IRS at * Mileage reimbursement rate is based on IRS regulation and subject to change. FLEX NOTE: You can save between 28% and 38% in taxes on every $100 you place in the Plan. Page 3

4 OVER-THE-COUNTER DRUGS Please be advised that recent Senate legislation has stated that participants are required to have a prescription for Over-the-Counter ( OTC ) products to be eligible under their FSA plan. OVER -THE-COUNTER EXPENSES Examples of medications and drugs that may be purchased in reasonable quantities with a prescription or letter of medical necessity: Antacids Pain relievers/aspirin Ointments & creams for joint pain First aid creams (Bactine, diaper rash) Allergy & sinus medication Cough & cold medications Laxatives Anti-diarrhea medicine Bug-bite medication OVER-THE-COUNTER EXPENSES THAT ARE NOT ELIGIBLE The following examples are OTC items that are not eligible and will not be reimbursed under any circumstances because the items are considered dietary supplements, toiletries, cosmetic or personal use items: Multi/Daily Vitamins Weight loss products/foods Face cream/moisteners Mouthwash/toothpaste Feminine hygiene products Deodorant Chapstick Suntan lotion DUAL PURPOSE DRUGS & ITEMS Herbal/natural supplements Acne creams/face cleanser Medicated shampoo/soaps Toothbrushes (even if dentist recommends a special one) Eye/facial makeup/preparations Rogaine EXPENSES THAT NEED DOCUMENTATION FROM YOUR PHYSICIAN TO BE ELIGIBLE THROUGH THE HEALTH CARE ACCOUNT The following items are examples of products that are considered as having both a medical purpose and a general health, personal/cosmetic purpose and require a medical practitioner s note stating the name of the patient, the specifi c medical condition for which the OTC is recommended, the time frame of the treatment and that the treatment is not cosmetic: Weight-loss drugs (to treat obesity) Prenatal vitamins Nasal sprays for snoring Pills for lactose intolerance Fiber supplements (to treat a medical condition for a limited time) OTC Hormone therapy (to treat menopausal symptoms) Glucosamine/Chondroitin (for arthritis) St. John s Wort (for depression) Page 4

5 EXPENSES FOR IMPROVEMENT OF GENERAL HEALTH are not eligible for reimbursement even if a doctor prescribes the program. However, if the program is prescribed for a specifi c medical condition (e.g. Obesity, Emphysema), then the expense would be eligible. We must have a letter from your doctor on fi le for each Plan Year stating specifi cally what illness or disease is being treated or prevented and the length of time you will be required to use this treatment in order to reimburse for any of these types of expenses. Health Club Dues Weight Loss Programs Wigs Exercise classes Exercise equipment NOTE: For Weight Loss Programs, only the cost of the program is an eligible expense. Any cost for food or food supplements is not an eligible expense. COSMETIC expenses, prescriptions and treatments are not eligible. This applies to any procedure that is directed at improving the patient s appearance and does not meaningfully promote the proper function of the body or prevent or treat an illness or disease. If cosmetic treatment is necessary to correct a deformity or abnormality, a personal injury or a disfi guring disease, it must meet IRS eligibility guidelines outlined in IRS publication 502 and will require a physician s letter of medical necessity. OTHER EXPENSES THAT ARE NOT ELIGIBLE FOR REIMBURSEMENT THROUGH THE HEALTH CARE ACCOUNT ESTIMATES for medical expenses that have not been rendered cannot be reimbursed. Medical services do not have to be paid for, however, the services must have been rendered during the Plan Year, to be eligible for reimbursement. PREMIUM EXPENSES for any insurance policies are not eligible for reimbursement through the Health Care Account. This includes contact lens insurance. EXPENSES PAID BY AN INSURANCE COMPANY are not eligible for reimbursement through the Health Care Account. Only the portion you have to pay out of your pocket for your medical expenses is eligible for reimbursement. CLAIMS SUBMISSION OBTAINING A REIMBURSEMENT FROM YOUR HEALTH CARE ACCOUNT To obtain a reimbursement from your Health Care Account, you must complete a Claim Form. This form is available from your employer's website (see sample claim form at the end of this summary). You must attach a receipt or bill from the service provider which includes all the pertinent information regarding the expense: Date of service Provider s name Patient s name Nature of the expense Amount charged Amount covered by insurance (if applicable) Page 5

6 Cash register receipts, credit card receipts and canceled checks alone are not eligible forms of documentation for medical expenses. These items are not considered third party receipts because they only refl ect that payment has been made and do not provide the required information listed above. Prescription documentation must include the name of the prescribed medication. OBTAINING A REIMBURSEMENT FOR OVER-THE-COUNTER ITEMS For the purchase of over-the-counter medications, with a prescription or letter of medical necessity, cash register receipts will be accepted as documentation if the receipt is detailed and indicates the name of the service provider, the date of the purchase, the amount of the purchase and the name of the product purchased. You must also send in a copy of the prescription or letter of medical necessity signed by a physician, along with your claim form. If the receipt does not specifi cally refl ect the name of the product we cannot accept the claim for reimbursement of that item. The name of the patient does not have to be on the receipt, however, the name of the patient must be listed on the claim form. NOTE: In order to be eligible for reimbursement through the Health Care Account, the medical expense must be incurred during the Plan Year. IRS defi nes incurred as when the medical care is provided (or date of service), not when you are formally billed, charged for, or pay for the care. FOR EXAMPLE: If you go to the doctor on July 26th and your Plan Year begins on August 1st, this expense is not eligible in the new Plan Year. Even if you pay for this expense after August 1st, the date of service was before the Plan Year began and therefore is not eligible. THE HEALTH CARE ACCOUNT IS A PRE-FUNDED ACCOUNT This means that you can submit a claim for medical expenses in excess of your account balance. You will be reimbursed your total eligible expense up to your annual election. The funds that you are pre-funded will be recovered as deductions continue to be deposited into your account throughout the Plan Year. FLEX NOTE: The minimum you may place in your Health Care account is $250. The maximum you can place in your Health Care Account is $2,500. Page 6

7 THE BENEFITS CARD The Benefi ts Card system allows you to pay for eligible pre-tax account expenses electronically at approved service providers and merchants. The Benefi ts Card provides you with instant access to your pre-funded Health Care Reimbursement Account for many common regular eligible expenses. You may also enjoy the convenience of paying for your childcare expenses (up to your account balance at the time of the swipe ) with the Benefi ts Card. In order for you to get the most benefi t from your Plan, we want to remind you of a few things concerning the Benefi ts Card. The Benefi ts Card works just like a debit card, only your bank account consists of the funds you elected to set aside in your pre-tax account(s). The card is not eligible for use at ATMs or other unqualifi ed merchant locations. The card will be denied at the point of sale when a transaction at an ineligible location is attempted. If an eligible provider does not accept MasterCard, you must fi le a paper claim. When using the card at a self-service merchant terminal, select the credit option, not the debit option (there is no PIN). Your card will be mailed to your home address via fi rst class mail. Please allow up to two weeks for delivery of your card. If you do not receive your card two weeks after the start of your Plan Year, contact Flexible Benefi t Administrators, Inc. so that a replacement card may be ordered. Any eligible expense incurred during that time may be reimbursed by mailing, faxing or ing a claim form and proper documentation to Flexible Benefi t Administrators, Inc., following the customary claims fi ling procedure and cutoff times. When you receive your card, sign the back of the card prior to using it. Your card is activated upon the fi rst swipe of your card. Continue to save all receipts. Flexible Benefi t Administrators, Inc. may request them to verify expense eligibility. Flexible Benefi t Administrators, Inc. will notify you by mail or if you incur an expense with the card that is or appears to be ineligible. Upon this notice you must send Flexible Benefi t Administrators, Inc. a Transaction Substantiation Form with the corresponding itemized documentation within 40 days of the transaction; you may download and print a Transaction Substantiation Form from our website. If you do not send in those required items, your card will be deactivated until the documentation is received. Your transaction will be denied for any amount greater than your health care reimbursement account annual election or your dependent care reimbursement account posted balance at the time of the swipe. You should notify Flexible Benefi t Administrators, Inc. immediately if your card is lost or stolen to deactivate the card. If your employment is terminated, your card will be permanently deactivated. You may monitor your account balance, transaction history or print a statement at any time, night or day on the Benefi ts Card website: Page 7

8 Additional information regarding the Benefi ts Card is available on our website: ex-admin.com. You may also download the Transaction Substantiation Form from our website under Participants; FBA Benefit Cards; Forms. Attention: Benefits Card Participant Subject: Benefits Card Use In light of IRS Rulings on Benefi ts Card use, it is important that you make yourself familiar with the cardholder agreement that accompanies your Benefi ts Card. Flexible Benefi t Administrators, Inc. strongly suggests reviewing this document and making yourself and any dependent cardholders in your household aware of the terms. Please be aware that upon receipt and signing of your Benefi ts Card, you, as the cardholder and employee participant of the Plan are ultimately responsible for using the card for eligible expenses. This also applies to any dependent that has use of the Benefi ts Card. By signing the back of the card, the employee/dependent is agreeing to the terms and conditions of this agreement. As in the past, your responsibility as a participant in a tax-free plan, is to use the card for eligible expenses ONLY (such as prescriptions, eyeglasses and medical co-pays, etc.) As with paper claim submission, cosmetic prescriptions and procedures as well as over the counter medications and products are not eligible for reimbursement. Please remember that each time you use your card you are certifying that the expense is eligible. If you have any doubt as to whether an expense is eligible or not you should refer to your employee handbook, IRS Publication 502 or call our offi ce to speak with one of our administrators. It is also your responsibility to acquire all documentation such as receipts, EOBs, etc. for the Plan Year s expenses and to retain the documentation for the entire Plan Year. If you are aware that you have paid for an expense with the card that is ineligible it is your responsibility to notify Flexible Benefi t Administrators, Inc. immediately. You will need to submit a paper claim form with substantiating documentation along with repayment for the amount of the ineligible expense. Flexible Benefi t Administrators, Inc. may request documentation to substantiate your Benefi ts Card transactions to determine eligibility of the expense. Please be aware that documentation for all over-the counter drugs will be required, as per IRS regulations. In the event that your documentation shows ineligible expenses were paid with your Benefi ts Card, Flexible Benefi t Administrators, Inc. will request that you re-pay the amount of the ineligible expense. If the payment is not received in the allotted time frame your card will be de-activated. Also, Flexible Benefi t Administrators, Inc. may offset future claims and notify your employer. IRS rulings allow your employer to withhold this amount from your wages if necessary. The Benefi ts Card is NOT PAPERLESS, just less paper and is a great convenience for the participants in the Plan, if used properly. PLEASE NOTE: Eligible items purchased at participating Inventory Information Approval System (IIAS) merchants will be automatically approved! When purchasing prescriptions and/or over-the-counter FSA-eligible items, the merchant s IIAS will verify the items and automatically approve the trans- Page 8

9 action with no follow-up request. The benefits card is not accepted at merchants who have not implemented IIAS. Please visit and select IIAS Merchants List for the most recent list of IIAS merchants. RULES AND REGULATIONS CLAIM FILING DATES All claims received in the office of Flexible Benefi t Administrators, Inc. will be processed within one week via check, or direct deposit. COMMON ERRORS TO AVOID WHEN FILING CLAIMS The claim form is not signed Canceled checks, cash register receipts or credit card receipts are sent in place of receipts or bills from the provider of service Cash register receipts for OTC item(s) do not indicate the specifi c name of the product(s) purchased Claim form has not been completed Insuffi cient postage on envelope Previous balance statements or payment on account receipts submitted in place of actual date of service itemized bills or receipts Your claim form may be returned to you or delayed in processing for improper or insuffi cient documentation. If you have questions about your claims, you may contact Flexible Benefi t Administrators, Inc. at (757) or (800) 437.FLEX, from 8:30 a.m. to 5:00 p.m., Monday through Friday. REIMBURSING THE PROVIDER OF SERVICE All reimbursements will be sent to you directly. After receiving payment from your account, you are responsible for paying your providers. ELIGIBLE DEPENDENTS An individual is considered to be a dependent if he or she is a qualifying child or qualifying relative of the taxpayer. The following qualifying criteria now apply. To be a dependent child : the individual is a child to the participant, and the individual doesn t turn 27, regardless of any other status by the end of the taxable year. In addition, the following qualifying criteria apply to be a dependent relative : the individual has a specifi c family type relationship to the taxpayer, the individual is not a qualifying child of any other taxpayer, the individual receives more than half of his or her support from the taxpayer, and the individual s annual gross income is less than the Section 151 limit ($3,200 for 2005; this criteria does not apply to health plans). GRACE PERIOD FOR FILING CLAIMS You have the entire Plan Year plus 60 days to fi le all claims that were incurred during the Plan Year. All claims must be received in the offi ce of Flexible Benefi t Administrators, Inc. by 5:00 p.m. on the 60th day, following the end of your Plan Year. If claims are not received during this time frame for expenses incurred during the Plan Year, your remaining funds will be forfeited. (Remember 60 days does not mean 2 months and received in the offi ce does not mean the day it was postmarked). Please, do not delay; complete your claims early. Page 9

10 FORFEITING FUNDS Any money you do not use from a reimbursement account for expenses incurred during a Plan Year will be forfeited. The forfeited funds will be returned to your employer to offset the cost of the program. If you plan carefully, you can avoid being affected by this IRS restriction. CHANGES IN YOUR ELECTION No, generally you cannot change the elections you have made after the beginning of the PLAN YEAR. However, there are certain limited situations when you can change your elections. You are permitted to change elections if you have a change in status and you make an election change that is consistent with the change in status. Currently, Federal law considers the following events to be changes in status : Marriage, divorce, death of a spouse, legal separation or annulment; Change in the number of dependents, including birth, adoption, placement for adoption, or death of a dependent Any of the following events for you, your spouse or dependent: Termination or commencement of employment, a strike or lockout, commencement or return from an unpaid leave of absence, a change in worksite, or any other change in employment status that affects eligibility for benefi ts; One of your dependents satisfi es or ceases to satisfy the requirements for coverage due to change in age, student status, or any similar circumstance and A change in place of residence of you, your spouse, or your dependent. This applies ONLY to Dependent Care and ONLY if that change results in a change of dependent care service provider and its cost. In addition, if you are participating in the Dependent Care Reimbursement Account, then there is a change in status if your dependent no longer meets the qualifi cations to be eligible for dependent care. You may not change your election under the Dependent Care Reimbursement Account if the cost change is imposed by a dependent care provider who is your relative. To make a change in your elections, a STATUS CHANGE FORM must be completed within 30 days of the event. Flexible Benefi t Administrators, Inc. or your benefi ts contact person will determine if your requests for an election change meets IRS Regulations. TRANSFERRING FUNDS BETWEEN ACCOUNTS IRS regulations do not allow money to be transferred between reimbursement accounts. If you elect funds to be placed in your Health Care Account, you must submit eligible medical expenses to be reimbursed from these funds. This IRS regulation also applies to the Dependent Care Account. Page 10

11 TERMINATION OF EMPLOYMENT If you have funds in your Health Care Account and you submit receipts for expenses incurred prior to your termination, you can be reimbursed for funds remaining in your account up to your annual election. However, if you have money left in your Health Care Account and do not have receipts for expenses incurred prior to your termination, you cannot be reimbursed for the money remaining in your account unless you elect to participate in the federal program, COBRA. If you elect to participate in COBRA, you will need to continue to set aside dollars on an after tax basis to be deposited into your Health Care account. You can receive information concerning this program from the contact person in your company. EFFECT ON SOCIAL SECURITY BENEFITS As you are not paying social security tax on the portion of your income that has been placed in the Plan, your social security benefits may be slightly reduced. We suggest putting part of your tax savings into your Employer s Retirement Program or some other savings vehicle. ACCOUNT BALANCES You may call Flexible Benefi t Administrators, Inc. at or from 8:30 a.m. to 5:00 p.m., Monday through Friday, to check your account balance. You may also access your personal account information at your convenience via our secure website: Each reimbursement check stub will show your contributions, request for reimbursements, and disbursements. It will also show your annual election and the balance to request by the end of the Plan Year for each account. A reminder letter will be sent two months prior to the end of the Plan Year if you have funds left in your account. Page 11

12 ESTIMATING YOUR EXPENSES This worksheet will help you determine your annual expenses for your Health Care Reimbursement account. Good planning and careful estimating is the best way to take full advantage of your Flexible Benefi t Plan. ESTIMATING YOUR QUALIFYING HEALTH CARE EXPENSES Medical deductibles Medical co-payments Prescription drugs Vision Exams, Glasses, Contacts Dental/Orthodontia Routine exams and physicals Over-the-counter expenses TOTAL ESTIMATED MEDICAL EXPENSES FOR THE PLAN YEAR (Min. $250, Max. $2,500) Page 12

13 FBA ANNOUNCES ITS ONLINE PHARMACY!! Busy day and don t have time to stop by the drugstore? Do you have unspent money in your FSA? Looking for savings from the comfort of your couch? Here s how! Visit ex-admin.com Click on More at the top header announcing the online pharmacy it s free to use! Shop and purchase items online at discounted pricing! You may use your FBA Benefi ts Card for eligible FSA items (marked )* and not have to submit receipts! Purchase non-eligible FSA items using your own personal payment method. All items are shipped directly to you! Free shipping on purchases over $25.00! Visit our website now to start making your life a little easier! * Please note if you do not have a FBA Benefi ts Card, you may purchase FSA Approved items out of pocket and submit to FBA for reimbursement. Page 13

14 Flexible Benefit Administrators Dependent Care Spending Account Plan Year: August 1, July 31, 2013 Dependent Care Flexible Spending Account Maximum: $5,000 Dependent Care Flexible Spending Account Minimum: $0 Debit card CAN be used with the Dependent Care account The Dependent Care Reimbursement Account allows you to pay for day care expenses for your dependents with tax-free dollars. ELIGIBLE DEPENDENT A child under 13 who qualifi es as a dependent on your Federal Income Taxes Any other dependents, including a disabled spouse, disabled children over age 13 and elderly parents, who depend on you for fi nancial support, qualify as dependents for tax purposes, and are incapable of self care A dependent, as revised under Section 152 of the Code by the Working Families Tax Relief Act of 2005 (WFTRA) ELIGIBLE DEPENDENT CARE EXPENSES For dependent care expenses to be eligible for reimbursement, you must be working during the time your eligible dependents are receiving care. If you are married, your spouse must be: Working at the time the day care services are provided; A full-time student for at least fi ve months during the year; or Mentally or physically disabled and unable to provide care for him or herself EXPENSES FOR KINDERGARTEN are not eligible for reimbursement since they are generally for education, and not for custodial care. In order for an expense to be eligible for reimbursement from the Dependent Care Reimbursement Account, the primary purpose for the care of the qualifying individual must be to assure the individual s well-being and protection. Dependent care must still be primarily for custodial care, not education, in order to qualify as an eligible employment-related expense from the Dependent Care Reimbursement Account. EXAMPLES OF DEPENDENT CARE EXPENSES Babysitters or Nannies that claim the child care as income on their taxes Licensed day care centers Private Preschool Before and after school care Day care for an elderly or disabled dependent EXPENSES THAT WOULD NOT BE ELIGIBLE THROUGH THE DEPENDENT CARE ACCOUNT Kindergarten (kindergarten & above is considered an educational expense) Days you or your spouse are not working including sick leave, vacation days, and maternity leave Page 14

15 Transportation, books, clothing, or entertainment (Note: These expenses will be covered if provided by the nursery school or day care center as part of its preschool care services. If these types of expenses are billed separately, they are not an eligible expense.) Care provider may not be a child of yours under the age of 19 or anyone you claim as a dependent for federal income tax purposes Babysitting for social events OVERNIGHT CAMP: Overnight camp is not an eligible expense, only DAY CAMPS are eligible. Remember that this account is set-up so that you and your spouse are able to go to work and Overnight camp is 24-hour care. ANNUAL MAXIMUM FOR THE DEPENDENT CARE REIMBURSEMENT AC- COUNT Must Not Exceed The Lesser Of: $5,000 for one or more children ($2,500 if you are a married individual fi ling a separate tax return); Your wages or salary for the Plan Year; or The wages or salary of your spouse If your spouse is either a full time student or is incapable of taking care of himself or herself then he or she is deemed to have monthly earnings of $250 if there is one (1) child or dependent, and $500 if there are two (2) or more children or dependents. USING THE DEPENDENT CARE REIMBURSEMENT ACCOUNT VERSUS FILING FOR A TAX CREDIT ON YOUR TAXES Under current IRS regulations, you may be eligible to receive a tax credit for dependent care costs. You may claim a credit for dependent care, up to $3,000 for one child and $6,000 for two or more children, on your income taxes through the child care tax credit. However, through the Dependent Care Reimbursement Account you may set aside up to $5,000 per year, for one or more children, if you are married and fi ling a joint tax return or if you are a single parent. If you are married and fi ling separate tax returns, you may set aside only $2,500. Typically, more money is saved by paying for dependent care through the FSA Dependent Care Reimbursement Account than by taking the dependent care credit on your tax return. This is because the total for federal, state, and FICA savings usually exceeds the dependent care credit. At taxable incomes greater than $14,000, participants will probably benefi t more from taking reimbursement from the Flexible Benefi t Plan. These assumptions are based on the inclusion of your state income tax. You can also file for the tax credit while participating in the Dependent Reimbursement Care Account. If the amount you have placed through the reimbursement account does not meet the maximum allowed by the IRS, you can claim the difference between your Dependent Care deductions and the IRS maximum allowable expenses for the tax credit. You can claim a tax credit for any additional dependent care expenses incurred over the $5,000 maximum FSA limit up to the $6,000 child care tax credit limit on your taxes. Page 15

16 You cannot claim the tax credit for any dependent care expenses paid from the Dependent Care Reimbursement Account. It is your responsibility to report the Dependent Care amount on your tax form The amount is listed on your W-2 under Dependent Care Benefi t for the tax year. If you are not sure about the eligibility of an expense, phone Flexible Benefi ts Administrators at or FLEX or refer to IRS Publication 503: Dependent Care Expenses. This publication can be ordered by calling the IRS at OBTAINING A REIMBURSEMENT FROM YOUR DEPENDENT CARE REIM- BURSEMENT ACCOUNT To obtain a reimbursement from your Dependent Care Reimbursement Account you must complete a Claim Form. This claim form is available from your employer (See sample Claim Form at the end of this summary). You must attach a receipt from the service provider which includes all of the following: Name of dependent receiving care Date(s) care was provided (must match Claim Form) Name of service provider Social Security or Tax I.D. number of the provider Amount of the charge NOTE: Dependent care expenses can only be reimbursed after the care is provided. This means that advance payments of dependent care expenses cannot be made. FOR EXAMPLE: If you pay for a summer day camp for your child in May but the camp is the fi rst week in July, we cannot reimburse you for this expense until July when the service is provided. THE DEPENDENT CARE REIMBURSEMENT ACCOUNT IS NOT A PRE- FUNDED ACCOUNT This means that you will only be reimbursed up to your account balance at the time you submit your claim. If your claim is for more than your account balance, the unreimbursed portion of your claim will be tracked by Flexible Benefi t Administrators. You will be automatically reimbursed as additional deductions are taken and deposited into your account, until your entire claim is paid out. ESTIMATING YOUR EXPENSES This worksheet will help you determine your annual expenses for the dependent care reimbursement account. Good planning and careful estimating is the best way to take full advantage of your Flexible Benefi t Plan. ESTIMATING YOUR DEPENDENT CARE EXPENSES Child day care expenses Pre-School expenses Summer Day Camp expenses Adult day care expenses Other eligible expenses TOTAL ESTIMATED DEPENDENT CARE EXPENSES FOR THE PLAN YEAR (Max. $5,000) Page 16

17 CABARRUS COUNTY SCHOOLS FLEXIBLE BENEFIT PLAN CLAIM FORM Employee s name SS# HEALTH CARE EXPENSES I, the participant, hereby fi le claim for the medical expense(s) noted below and certify that each expense was incurred on the date and for the person and reason noted. The expense(s) listed below was incurred for medical care not general health purposes and exclude cosmetic and/or toiletries expense(s). I, the participant, certify that I have not been reimbursed for the expense(s) noted below and that I will not seek reimbursement under any other plan covering health benefits. I, the participant, further certify that the expense(s) noted below have not been previously paid for by use of my Benefi ts Card. Attached are receipts or bills as evidence of my expenses incurred during the Plan Year. ** Please note: A doctor s note must be attached if considered a dual purpose drug Date of Treatment Person treated & Type of Expense Amount of Expense relationship TOTAL $ $ $ $ $ $ DEPENDENT CARE EXPENSES I, the participant, hereby fi le claim for the child or dependent care expense(s) noted below and certify that each expense was incurred on the dates and for the persons noted. I, the participant, certify that I have not been reimbursed for the expense(s) noted below and that I will not seek reimbursement under any other plan. I, the participant, further certify that the expense(s) noted below have not been previously paid for by use of my Benefits Card. Attached are receipts or bills as evidence of my expenses incurred during the Plan Year. Please note that receipts must come from the day care provider and have the dates of service, a description of the expense, the amount charged and the provider s SS# or Tax ID#. Care Provided Date Care Provided Person cared for & Amount of Expense By: relationship NAME ADDRESS TAX ID OR SS# Mail This Claim Form To: Flexible Benefi t Administrators, Inc. P.O. Box 8188, Virginia Beach, VA, Page 17 $ $ $ $ $ $ TOTAL $ I authorize the service provider to release any information requested by the Plan Administrator in connection with this request for reimbursement. EMPLOYEE S SIGNATURE DATE Fax Claim Form To: Please Include Cover Sheet Flexible Benefi t Administrators, Inc. Fax Number: Scan and This Claim Form To: Flexible Benefi t Administrators, Inc. PLEASE: FlexDivision@fl ex-admin.com DO NOT mail your claim form if you fax it. KEEP a copy of all claim forms and receipts for your records NOTIFY Flexible Benefits Administrators, Inc. if you have a change in address Copyright Flexible Benefi t Administrators, Inc.

18 ACCESSING YOUR FLEX ACCOUNT ONLINE Our secure Online Inquiry System allows you to have 24/7 access to your account information, payment information and your available balance. Completing your online account set-up is just a few clicks away! Step 1. Log-on to our website at ex-admin.com Step 2. Select FLEX Participants Step 3. Select ACCOUNT LOG IN under the appropriate account type that you participate in. Please note that if you participate in more than one type of account, you do not have to set up a separate account for each one. You will be able to see all your account information under the one User ID and Password you create. Step 4. Select Participant Login Step 5. Select Create Account Step 6. You will be prompted to enter your Name and Employee ID number Step 7. You must then enter your Benefi ts Card Number or, if you do not have a Benefi ts Card, you may enter your Employer ID, which is: FBACAB Step 8. Create your User ID, Password, Security Word and Birth City and your address. Please note that your User ID will need to be between 4-10 characters. Your password needs to be between 7-10 characters and must include at least one letter and number. Step 9. You are now ready to access your individual account! Once you have completed these steps, you will have 24/7 access to current information regarding your Flexible Spending Account. It s that easy! Problems Logging into your Account? to: flexdivision@flex-admin.com Include your Full Name, SS# or Employee ID#, Company Name, & Contact phone number Telephone: Local or Toll Free (Monday-Friday 8:30a-5:00p EST) Page 18

19 ADMINISTERED BY FLEXIBLE BENEFIT ADMINISTRATORS, INC. 509 VIKING DRIVE, SUITE F P.O. BOX 8188 VIRGINIA BEACH, VA or FLEX FAX: FlexDivision@flex-admin.com Page 19

20 Effective Date: August 1, 2012 Ameritas Dental Plan IMPORTANT NOTE- PPO ACCESS: All full time eligible employees will now have access to the Ameritas PPO (Participating Provider Organization) network. As an insured member, you will continue to have the freedom to go to any provider you choose. However; should you visit an Ameritas PPO provider, a negotiated fee schedule is used. This negotiated fee is intended to provide you with potentially reduced out-of-pocket costs. If you choose to visit a doctor outside the panel, you are not penalized and you are still reimbursed at your current claim allowance. To locate a participating provider, go to www. ameritasgroup.com and select 'Find A Provider'. Choose the PPO-Nationwide network option. CALENDAR YEAR DEDUCTIBLE $50.00 per individual for Type 2 (Basic) and Type 3 (Major) Procedures (3 times family limit) After the date that 3 members of a family have each satisfi ed their individual deductible, the entire deductible or any remaining portion of the deductible for any family member will be waived for the rest of that calendar year. TYPE 1- PREVENTIVE AND DIAGNOSTIC Type 1 benefi ts are payable at 100% U&C*. No deductible applies. Evaluations (Two per benefi t period) Space Maintainers Cleanings (Two per benefi t period) Radiographs (X-rays) Fluoride for Children (Under age 19) Bitewings (Two per benefi t period) TYPE 2- BASIC PROCEDURES Type 2 benefi ts are payable at 80% U&C*. $50.00 deductible applies. Sealants (Under age 17) Anesthesia Limited Exams (Problem Focused) Oral Surgery - Complex Extractions Bridge and Denture Repair Restorative Amalgam and Resin Oral Surgery TYPE 3- MAJOR PROCEDURES Type 3 Benefi ts are payable at 50% U&C*. $50.00 deductible applies. Endodontics (Root Canal) Restorative - Crowns Periodontics (Gum Disease) Prosthodontics - Fixed Pontics Crowns and Crown Repair Partials and Dentures * Usual & Customary Page 20

21 ORTHODONTIA- FOR ADULTS AND CHILDREN Paid at 50% U&C* with a $1,000 lifetime maximum per person. No deductible applies. ANNUAL MAXIMUM BENEFIT Type 1, Type 2, and Type 3 Procedures: $1,000 per calendar year per person. ANNUAL MAXIMUM CARRYOVER Each insured (employee and/or dependent) will qualify for a dental maximum carryover if they: 1. Visit a dentist between January 1 and December 31 of the plan year. 2. Submit a claim for payment prior to March 1 of the following year. 3. Total benefi ts paid for the Calendar Year must be less than $500. If you meet all 3 requirements you will have an additional $250 available in the Annual Dental Maximum for the next plan year. In future years if you have benefi ts paid of less than $500, additional amounts of $250 will be added to the carryover. However, the most you can accumulate in the maximum carryover is $1,000. Therefore, the maximum annual benefi t may never exceed $2,000 in any one year. LATE ENTRANT PROVISION There is a 12 month waiting period on all services except for cleanings, exams, and fl uoride applications for employees who do not enroll when fi rst eligible for coverage. The waiting period will be waived for employees who enroll when fi rst eligible. ELIGIBLE EMPLOYEES You are eligible for insurance if you are a full-time active employee working at least 30 hours per week. ELIGIBLE DEPENDENTS Provides Coverage On: Your Spouse Children up to age 19 and unmarried (Up to age 24 if wholly dependent upon you for maintenance and support and if enrolled as a full-time student in an accredited school or college.) DENTAL EXCLUSIONS (DEFERMENT PERIOD) During the fi rst 36 months following your or your dependent's Dental Coverage Effective Date, the initial placement of dentures, partial dentures, or bridges, if it includes the replacement of teeth all of which are missing prior to the effective date. (For currently covered insureds, Ameritas will use the employees Date of Hire to determine the 36 month period.) This exclusion will not apply if the prosthesis replaces a sound natural tooth which is extracted while the patient is insured under this Dental Coverage and which is replaced within 12 months of the extraction. During the fi rst 36 months of coverage, the replacement of bridges, partial dentures, dentures, inlays or crowns is excluded. * Usual & Customary Page 21

22 EXCEPTIONS to this exclusion will be made if the replacement is made necessary by: a) accidental bodily injury to sound natural teeth (chewing injuries are not considered accidental bodily injuries), or b) the extraction of a sound natural tooth provided the replacement is completed within 12 months of the date of the injury or extraction. PREDETERMINATION OF BENEFITS A treatment plan MAY be fi led if a proposed course of treatment will exceed $ With this information, Ameritas can determine the benefits payable under this policy prior to the work actually being done. It will give the insured the amount payable, along with an idea of the out of pocket expense. LIMITATIONS/EXCLUSIONS (This is not a complete List) For any treatment which is for cosmetic purposes. Facings on crowns or pontics behind the 2nd bicuspid are considered cosmetic. Charges incurred prior to the date the individual became insured under this plan, or following the date of termination of coverage. Services which are not recommended by a dentist or which are not required for necessary care and treatment. Expenses incurred to replace lost or stolen appliances. Expenses incurred by an insured because of a sickness for which he /she is eligible for benefi ts under Worker's Compensation Act or similar laws. COORDINATION OF BENEFITS If you or any of your dependents incur charges which are covered by any other group plan, the benefits of this plan will be coordinated with the benefi ts of the other plan so that the total benefi ts received are not greater than the charges incurred. CHANGING ELECTIONS A member may change their election only during an annual election period, except for a change in family status. Examples of such events would be marriage, divorce, birth of a child, death of a spouse or child or termination of employment. Please see your plan administrator for details. ORTHODONTIA LIMITATIONS (This is not a complete list) No benefi t is payable for expenses incurred: In connection with a Treatment Program which was begun before the individual became insured for orthodontic benefi ts. During any quarter of a Treatment Program if the individual was not continuously insured for orthodontic benefi ts for the entire quarter. After the individual's insurance for orthodontic benefi ts terminates. CERTIFICATE OF INSURANCE The Certifi cate of Insurance issued to you describes in detail the benefi ts and limitations of this plan. The information in this booklet is for general information only. Page 22

23 Ameritas Dental Plan Insureds 12 pay periods Employee Only $32.98 Employee + One $63.86 Employee + Two or More $ Ameritas Dental Plan Insureds 10 pay periods Employee Only $39.58 Employee + One $76.63 Employee + Two or More $ Ameritas Dental Plan Insureds 20 pay periods Employee Only $19.79 Employee + One $38.32 Employee + Two or More $66.68 Ameritas Dental Plan Insureds 24 pay periods Employee Only $16.49 Employee + One $31.93 Employee + Two or More $55.57 For Claims/Customer Service call Ameritas at: Website: This insurance is underwritten by Ameritas Life Insurance Corp. Page 23

24 Community Eye Care Vision Plan Effective Date: August 1, 2012 CEC Gold Plan BENEFITS Comprehensive Eye Examination FREQUENCY 12 Months $150 Allowance for Frames, Lenses, 12 Months and Contact Lenses (No limitations on choice of eyewear) CO-PAYMENT AMOUNT Examination: $20 Contact lens fi tting (if one is performed): $20 HOW TO USE YOUR BENEFIT Select a doctor from the Community Eye Care Provider Network. Call the doctor s offi ce to make an appointment, and let them know that you have the Community Eye Care vision plan. Give them your Member ID Number. The doctor s staff will then contact Community Eye Care to verify eligibility. See the doctor. Pay the $20 exam co-payment at the time of your visit. If the eyewear you ve selected exceeds your $150 allowance, you simply pay the balance. EXCLUSIONS & LIMITATIONS The eye examination and the eyewear allowance must be utilized at a participating provider s offi ce. The Community Eye Care vision plan applies solely to routine vision care. The following are not covered under the plan: a) medical eye care, b) surgical eye care, c) low vision services, d) emergency eye care e) periodic contact lens evaluation. Benefi ts may not be carried forward to a subsequent benefi t period. There is no coordination of benefi ts. Page 24

25 The member is responsible for payment to the provider of any dollar amount exceeding the eyewear allowance. All co-payments are to be paid to the provider at the time professional services are rendered. The member s vision benefi t coverage will remain in effect for a minimum of twelve months, unless the member is terminated from employment or there is a status change. Community Eye Care Vision Plan Insureds 12 pay periods Employee Only $9.75 Employee + One $18.53 Employee + Family $27.30 Community Eye Care Vision Plan Insureds 10 pay periods Employee Only $11.70 Employee + One $22.24 Employee + Family $32.76 Community Eye Care Vision Plan Insureds 20 pay periods Employee Only $5.85 Employee + One $11.19 Employee + Family $16.38 Community Eye Care Vision Plan Insureds 24 pay periods Employee Only $4.88 Employee + One $9.27 Employee + Family $13.65 Member Services, Provider Services, and Claims Services: FAX: Website: Perimeter Pointe Parkway Suite 150 Charlotte, NC Page 25

26 Allstate Group Cancer Plan Effective Date: August 1, 2012 In the United States, about 1,529,560 new cancer cases were expected to be diagnosed in Group Voluntary Cancer If you suddenly become diagnosed with cancer, it can be diffi cult on your family s fi nancial and emotional stability. Having the right coverage to help when you are sick and undergoing treatment or when you cannot work is important. Our cancer insurance can help provide security when you need it most. Meeting Your Needs: Our cancer coverage can help offer you and your family members fi nancial support during a period of unexpected illness. Benefi ts will be paid directly to you unless otherwise assigned Coverage can be purchased for you and your entire family No evidence of insurability required at initial enrollment for new hires Waiver of premium after 90 days of disability due to cancer for as long as your disability lasts* Includes coverage for 29 other specifi ed diseases** Portable coverage Benefit Coverage Highlights Group Voluntary Cancer Insurance offers you coverage should you be diagnosed with cancer or 29 specifi ed diseases. It protects you and your family 24 hours a day, seven days a week. Each pre-packaged plan doesn t just cover you; if you choose, it also covers your dependents (which can include spouse, domestic partner and dependent children.) Our valuable coverage can help supplement your traditional medical insurance which may only cover a small portion of the non-medical expenses that can be incurred with such a diagnosis as cancer. You and each covered family member can be sure they will receive: Benefi ts that can be used to help pay for treatment, hospital stays, transportation, and more! Easy enrollment without required evidence of insurability for qualifi ed employees Benefi t coverage that includes 29 other specifi ed diseases A cancer diagnosis can mean unforeseen expenses that may be diffi cult to pay, especially if you aren t working. Hospital stays, medical or surgical treatments, and transportation by air or ground ambulance can add up quickly and be very costly. Our Group Voluntary Cancer Supplemental Insurance helps offset some of the expenses your health insurance may not cover, so you can focus on getting well. *Primary insured only **List of covered diseases on page 27 Cancer Facts & Figures, American Cancer Society, 2010 Page 26

27 In the U.S., men have slightly less than a 1 in 2 lifetime risk of developing cancer; for women, the risk is a little more than 1 in 3. 2 Your Benefit Coverage Benefi ts are paid for cancer and specifi ed disease and can help cover the costs of specifi c treatments and expenses as they happen. Terms and conditions for each benefi t will vary. Specified Diseases Amyotrophic Lateral Sclerosis (Lou Gehrig s Disease),Muscular Dystrophy, Poliomyelitis, Multiple Sclerosis, Encephalitis, Rabies, Tetanus, Tuberculosis, Osteomyelitis, Diphtheria, Scarlet Fever, Cerebrospinal Meningitis (bacterial), Brucellosis, Sickle Cell Anemia, Thallasemia, Rocky Mountain Spotted Fever, Legionnaire s Disease (confi rmation by culture or sputum), Addison s Disease, Hansen s Disease, Tularemia, Hepatitis (Chronic B or Chronic C with liver failure or Hepatoma), Typhoid Fever, Myasthenia Gravis, Reye s Syndrome, Primary Sclerosing Cholangitis (Walter Payton s Liver Disease), Lyme Disease, Systemic Lupus Erythematosus, Cystic Fibrosis, and Primary Biliary Cirrhosis. Continuous Hospital Confinement A $100 benefit will be paid for each day of continuous hospital confi nement for the treatment of cancer or specifi ed diseases. Government or Charity Hospital A $100 benefit will be paid for each day a covered person is confi ned to: 1. a hospital operated by or for the U.S. Government (including the Veteran s Administration); or 2. a hospital that does not charge for the services it provides (charity). This benefi t is paid in lieu of all other benefi ts in the policy (except Waiver of Premium Benefi t). Surgery** Up to a $3,000 benefit will be paid when a covered surgery (**amount per surgery depends on surgery) is performed on a covered person. This benefi t pays the actual charges, up to the amount listed in the Schedule of Surgical Procedures for the specifi c procedure. Two or more procedures performed at the same time through one incision or entry point are considered one operation; Allstate Benefi ts pays the amount for the procedure with the greatest benefi t. AB pays for a covered surgery performed on an outpatient basis at 150% of the scheduled benefi t. This benefi t does not pay for surgeries covered by other benefi ts in the Schedule of Benefi ts. 2 Cancer Facts & Figures, American Cancer Society, Page 27

28 Second Opinion A $400 benefit will be paid for a second surgical opinion, if physician recommends surgery for covered condition. This second opinion must be rendered prior to surgery or treatment being performed, and obtained from a physician not in practice with the physician rendering the original recommendation. Physical or Speech Therapy A $50 benefit will be paid per day, for physical or speech therapy for restoration of normal body function. Anesthesia 25% of the surgery benefit will be paid for anesthesia received by an anesthetist. Ambulatory Surgical Center A $500 benefit will be paid for the use of an Ambulatory Surgical Center day for a surgical procedure covered under the Surgery benefi t that is performed at an ambulatory surgical center. Radiation/Chemotherapy for Cancer Up to a $10,000 (Low) or $20,000 (High) benefit will be paid per 12 month period for radiation therapy and chemotherapy received by a covered person. This benefi t pays the actual cost and is limited to the amount shown per 12 month period beginning with the fi rst day of benefi t under this provision. Administration of radiation therapy or chemotherapy other than by medical personnel in a physician s offi ce or hospital, including medications dispensed by a pump, will be limited to the costs of the drugs only, subject to the maximum amount payable per 12 month period. Anti-Nausea Benefit Up to a $200 benefit will be paid per calendar year for the actual cost of antinausea medication prescribed for a covered person by a physician. This benefi t does not pay for medication administered while the covered person is an inpatient. Inpatient Drugs and Medicine A $25 benefit will be paid per day for drugs and medicine while continuously hospital confi ned. This benefi t does not pay for drugs and/or medicine covered under the Radiation/Chemotherapy Benefi t or the Anti-Nausea Benefi t. Hematological Drugs Up to a $200 (Low) or $400 (High) benefit will be paid per year for the actual cost of drugs intended to boost cell lines such as white blood cell counts, red blood cell counts and platelets. This benefi t is paid only when the Radiation/ Chemotherapy for Cancer benefi t is paid. Page 28

29 Medical Imaging Actual cost up to a $500 (Low) or $1,000 (High) benefit will be paid per calendar year if a covered person receives an initial diagnosis or follow-up evaluation based upon one of the following medical imaging exams: CT scan; Magnetic Resonance Imaging (MRI) scan; bone scan; thyroid scan; Multiple Gated Acquisition (MUGA) scan; Positron Emission Tomography (PET) scan; transrectal ultrasound; or abdominal ultrasound. This benefi t is limited to 1 payment per calendar year per covered person. Private Duty Nursing Services A $100 benefit will be paid per day while hospital confi ned, if a covered person requires the full-time services of a private nurse. Full-time means at least 8 hours of attendance during a 24 hour period. These services must be required and authorized by a physician and must be provided by a nurse. New or Experimental Treatment Actual charges up to a $5,000 benefit will be paid per 12 month period, for new or experimental treatment. New or Experimental Treatment is covered for cancer and specifi ed disease when: the treatment is judged necessary by the attending physician; and no other generally accepted treatment produces superior results in the opinion of the attending physician. This benefit is limited to the maximum shown per 12 month period beginning with the fi rst day of treatment under this provision. This benefit does not pay if benefi ts are payable for treatment covered under any other benefi t in the Schedule of Benefi ts. Blood, Plasma, and Platelets Up to a $10,000 (Low) or $20,000 (High) benefit will be paid per 12 month period for the actual cost of blood, plasma and platelets (including transfusions and administration charges); processing and procurement costs; and cross-matching. Does not pay for blood replaced by donors or immunoglobulins. Physician s Attendance A $50 benefit will be paid for a visit by a physician during hospital confi nement. Benefi t is limited to one visit by one physician per day of hospital confi nement. Admission to the hospital as an inpatient is required. At Home Nursing A $100 benefit will be paid per day for private nursing care and attendance by a nurse at home. At home nursing services must be required and authorized by the attending physician. Benefi t is limited to the number of days of the previous continuous hospital confi nement. Prosthesis Up to a $2,000 benefit will be paid per amputation, per covered person for the actual charges for prosthetic devices which are prescribed as a direct result of surgery and which require surgical implantation. Page 29

30 Hair Prosthesis A $25 benefit will be paid every 2 years, for a wig or hairpiece if the covered person experiences hair loss. Nonsurgical External Breast Prosthesis Up to a $50 benefit will be paid for the actual cost of the initial, nonsurgical breast prosthesis following a covered mastectomy or partial mastectomy that is paid for under the policy. Ambulance A $100 benefit will be paid per continuous hospital confi nement for transportation by a licensed ambulance service or a hospital owned ambulance to or from a hospital in which the covered person is confi ned. Hospice Care A $100 benefit will be paid for one of the following when a covered person has been diagnosed by a physician as terminally ill as a result of cancer or specifi ed disease, is expected to live 6 months or less and the attending physician has approved services: 1. Freestanding Hospice Care Center A benefi t will be paid per day for confi nement in a licensed freestanding hospice care center. Benefi ts payable for hospice centers that are designated areas of hospitals will be paid the same as inpatient hospital confi nement; or 2. Hospice Care Team A benefi t will be paid per visit, limited to 1 visit per day, for home care services by a hospice care team. Home care services are hospice services provided in the patient s home. Benefi t is payable only if: (a) the covered person has been diagnosed as terminally ill; and (b) the attending physician has approved such services. Does not pay for: food services or meals other than dietary counseling; or services related to well-baby care; or services provided by volunteers; or support for the family after the death of the covered person. Extended Care Facility A $100 benefit will be paid for each day a covered person is confi ned in an extended care facility for the treatment of cancer or specifi ed disease. Confi nement must be at the direction of the attending physician and must begin within 14 days after a covered hospital confi nement. Benefi t is limited to the number of days of the previous continuous hospital confi nement. Outpatient Lodging A $50 benefit will be paid for lodging per day when a covered person receives radiation or chemotherapy treatment on an outpatient basis, provided the specifi c treatment is authorized by the attending physician and cannot be obtained locally. Benefi t is for a single room in a motel, hotel, or other accommodations acceptable to AB during treatment, up to the maximum $2,000 per 12 months beginning with the fi rst day of benefi t under this provision. Outpatient treatment must be received at a treatment facility more than 100 miles from the covered person s home. Page 30

31 Non-Local Transportation $0.40 per mile or actual cost of round trip coach fare on a common carrier benefit will be paid for treatment at a hospital (inpatient or outpatient); or radiation therapy center; or chemotherapy or oncology clinic; or any other specialized freestanding treatment center nearest to the covered person s home, provided the same or similar treatment cannot be obtained locally. Benefi t pays up to 700 miles for round trip in personal vehicle. Non-Local means a round trip of more than 70 miles from the covered person s home to the nearest treatment facility. Mileage is measured from the covered person s home to the nearest treatment facility as described above. Does not cover transportation for someone to accompany or visit the person receiving treatment; visits to a physician s offi ce or clinic; or for services other than actual treatment. Family Member Lodging and Transportation Up to a $50 benefit per day will be paid for lodging and $0.40 per mile or the actual cost of round trip coach fare on a common carrier will be paid for one adult member of the covered person s family to be near the covered person, when a covered person is confi ned in a non-local hospital for specialized treatment. 1. Lodging -This benefi t is for a single room in a motel, hotel, or other accommodations acceptable to AB. Benefi t is limited to 60 days for each period of continuous hospital confi nement. 2. Transportation -Benefi t is limited to 700 miles per continuous hospital confi nement if traveling in personal vehicle. Mileage is measured from the visiting family member s home to the hospital where the covered person is confi ned. Does not pay the Family Member Transportation Benefi t if the personal vehicle transportation benefi t is paid under the Non-Local Transportation Benefi t, when the family member lives in the same city or town as the covered person. Waiver of Premium (primary insured only) If, while coverage is in force the insured employee becomes disabled due to cancer fi rst diagnosed after the effective date of coverage and remains disabled for 90 days, AB pays premiums due after such 90 days for as long as the insured employee remains disabled. Bone Marrow or Stem Cell Transplant* A 1. $1,000*, 2. $2,500*, 3. $5,000* benefit will be paid for the following types of bone marrow or stem cell transplants performed on a covered person. 1. A transplant which is other than non-autologous. 2. A transplant which is non-autologous for the treatment of cancer or specifi ed disease, other than Leukemia. 3. A transplant which is non-autologous for the treatment of Leukemia. *This benefit is payable only once per covered person per calendar year. Page 31

32 ADDITIONAL BENEFIT Wellness A $100 benefit will be paid per calendar year per covered person for one of the following wellness tests: Biopsy for skin cancer; Blood test for triglycerides; Bone Marrow Testing; CA15-3 (cancer antigen blood test for breast cancer); CA125 (cancer antigen 125 blood test for ovarian cancer); CEA (carcinoembryonic antigen blood test for colon cancer); Chest X-ray; Colonoscopy; Doppler screening for carotids; Doppler screening for peripheral vascular disease; Echocardiogram; EKG (Electrocardiogram); Flexible sigmoidoscopy; Hemocult stool analysis; HPV (Human Papillomavirus) Vaccination; Lipid panel (total cholesterol count); Mammography, including Breast Ultrasound; Cervical Cancer Screening; PSA (prostate specifi c antigen blood test for prostate cancer); Serum Protein Electrophoresis (test for myeloma); Stress test on bike or treadmill; Thermography; and Ultrasound screening of the abdominal aorta for abdominal aortic aneurysms. This benefi t is paid regardless of the result of the test. OPTIONAL BENEFITS Cancer Initial Diagnosis (First Occurrence) A one time benefit of $3,000 benefit will be paid when a covered person is diagnosed for the fi rst time in their life as having cancer other than skin cancer. The fi rst diagnosis must occur after the effective date of coverage for that covered person. Benefi t is payable only once per covered person. Intensive Care A benefit will be paid for each day for the following types of intensive care confi nement: A. Hospital Intensive Care Unit Confinement $600* - This benefi t is for hospital intensive care unit confi nement for any illness or accident. B. Step-Down Hospital Intensive Care Unit Confinement $300*- This benefi t is for step-down hospital intensive care unit confi nement for any illness or accident. C. Ambulance - AB pays the actual charges for transportation of a covered person by licensed air or surface ambulance service to a hospital for admission to an intensive care unit for a covered confi nement. This benefi t is not paid if an ambulance benefi t is paid under the Ambulance benefi t in the policy. *This benefit is limited to 45 days for each period of such confinement. A day is a 24 hour period. If confinement is for only a portion of a day, then a pro-rata share of the daily benefit is paid. Issue Ages: 18 and older while actively at work. Certificates- Certifi cates under this plan are issued on a guaranteed basis only at the time of the initial enrollment. A completed Evidence of Insurability form is required for late entrants into the group plan. Page 32

33 Allstate Benefits Group Cancer Rates Low Option without Cancer Initial Diagnosis and Intensive Care Insureds 12 pay periods Employee $20.07 Employee + Child(ren) $27.71 Employee + Spouse $30.96 Family $38.57 Low Option with Cancer Initial Diagnosis and Intensive Care Insureds 12 pay periods Employee $26.06 Employee + Child(ren) $36.81 Employee + Spouse $41.50 Family $52.23 High Option without Cancer Initial Diagnosis and Intensive Care Insureds 12 pay periods Employee $31.09 Employee + Child(ren) $43.65 Employee + Spouse $47.51 Family $60.04 High Option with Cancer Initial Diagnosis and Intensive Care Insureds 12 pay periods Employee $37.08 Employee + Child(ren) $52.75 Employee + Spouse $58.05 Family $73.70 Page 33

34 Allstate Benefits Group Cancer Rates Low Option without Cancer Initial Diagnosis and Intensive Care Insureds 10 pay periods Employee $24.09 Employee + Child(ren) $33.26 Employee + Spouse $37.16 Family $46.29 Low Option with Cancer Initial Diagnosis and Intensive Care Insureds 10 pay periods Employee $31.28 Employee + Child(ren) $44.18 Employee + Spouse $49.80 Family $62.68 High Option without Cancer Initial Diagnosis and Intensive Care Insureds 10 pay periods Employee $37.31 Employee + Child(ren) $52.38 Employee + Spouse $57.02 Family $72.05 High Option with Cancer Initial Diagnosis and Intensive Care Insureds 10 pay periods Employee $44.50 Employee + Child(ren) $63.30 Employee + Spouse $69.66 Family $88.44 Page 34

35 Allstate Benefits Group Cancer Rates Low Option without Cancer Initial Diagnosis and Intensive Care Insureds 20 pay periods Employee $12.05 Employee + Child(ren) $16.63 Employee + Spouse $18.58 Family $23.15 Low Option with Cancer Initial Diagnosis and Intensive Care Insureds 20 pay periods Employee $15.64 Employee + Child(ren) $22.09 Employee + Spouse $24.90 Family $31.34 High Option without Cancer Initial Diagnosis and Intensive Care Insureds 20 pay periods Employee $18.66 Employee + Child(ren) $26.19 Employee + Spouse $28.51 Family $36.03 High Option with Cancer Initial Diagnosis and Intensive Care Insureds 20 pay periods Employee $22.25 Employee + Child(ren) $31.65 Employee + Spouse $34.83 Family $44.22 Page 35

36 Allstate Benefits Group Cancer Rates Low Option without Cancer Initial Diagnosis and Intensive Care Insureds 24 pay periods Employee $10.04 Employee + Child(ren) $13.86 Employee + Spouse $15.48 Family $19.29 Low Option with Cancer Initial Diagnosis and Intensive Care Insureds 24 pay periods Employee $13.03 Employee + Child(ren) $18.41 Employee + Spouse $20.75 Family $26.12 High Option without Cancer Initial Diagnosis and Intensive Care Insureds 24 pay periods Employee $15.55 Employee + Child(ren) $21.83 Employee + Spouse $23.76 Family $30.02 High Option with Cancer Initial Diagnosis and Intensive Care Insureds 24 pay periods Employee $18.54 Employee + Child(ren) $26.38 Employee + Spouse $29.03 Family $36.85 Page 36

37 Eligibility - Family members eligible for coverage include: you; your legal spouse or domestic partner; and your unmarried children including adopted children or foster children from the moment of placement in the residence, stepchildren, children of a domestic partner, or legal ward to 26 years of age, unless he or she continues to meet the defi nition of a dependent. Your children must be dependent on you for support or reside with you and be named on the enrollment or evidence of insurability form. Portability Privilege -AB will provide portability coverage, subject to these provisions. Such coverage will not be available for you unless: coverage under the policy terminates under the General Provision entitled Termination of Coverage ; and AB receives a written request and payment of the fi rst premiums for the portability coverage not later than 63 days after such termination; and the request is made for that purpose. No portability coverage will be provided to you, if your insurance under the policy terminates due to your failure to make required premium payments. Termination of Coverage - As long as you are insured, your coverage under the policy ends on the earliest of: the date the policy is canceled; or the last day of the period for which you made any required premium payments; or the last day you are in active employment except as provided under the Temporary Layoff, Leave of Absence or Family and Medical Leave of Absence provision; or the date you are no longer in an eligible class; or the date your class is no longer eligible. AB will provide coverage for a payable claim incurred while you are covered under the policy. If your spouse is a covered person, the spouse s coverage ends upon valid decree of divorce or your death. If your domestic partner is a covered person, the domestic partner s coverage ends upon termination of the domestic partnership or your death. If your child is a covered person, the child s coverage ends when the child reaches age 26, unless he or she continues to meet the requirements of an eligible dependent. Coverage does not terminate on a child who: 1. is incapable of self-sustaining employment by reason of mental or physical incapacity; and 2. became so incapacitated prior to the attainment of the limiting age of eligibility under the coverage; and 3. is chiefl y dependent upon you for support and maintenance. Dependent coverage continues as long as the coverage remains in force and the dependent remains in such condition. Proof of the incapacity and dependency of the child must be furnished within 60 days of the child s attainment of the limiting age of eligibility. Thereafter, such proof must be furnished as frequently as may be required, but no more frequently than annually after the child s attainment of the limiting age for eligibility. If AB accepts a premium for coverage extending beyond the date, age, or event specifi ed for termination as to a covered person, such premium will be refunded, coverage will terminate and claims will not be paid. Page 37

38 Pre-Existing Condition - AB does not pay for any benefi t due to, or caused by, a pre-existing condition, as defi ned, during the 12 month period beginning on the date that person became a covered person. This exclusion will not apply to your newborn child, adopted child or foster child under the age of 18 if AB is notifi ed within 31 days of the child s birth or date of placement. A Pre-Existing Condition is a disease or physical condition for which medical advice or treatment was recommended or received from a member of the medical profession within the 12 month period prior to the effective date of coverage. Exclusions and Limitations - AB does not pay for any loss except for losses due directly from cancer or specifi ed disease. AB does not pay for any other conditions or diseases caused or aggravated by cancer or a specifi ed disease. Diagnosis must be submitted to support each claim. For the Surgery, New or Experimental Treatment and Prosthesis Benefi ts, if specifi c charges are not obtainable as proof of loss, AB will pay 50% of the applicable maximum for the benefi ts payable. Treatment must be received in the United States or its territories. Intensive Care Exclusions and Limitations - The Hospital Intensive Care Unit Confi nement benefi t does not pay for intensive care if a covered person is admitted because of an attempted suicide; or intentional self-infl icted injury; or intoxication or being under the infl uence of drugs not prescribed or recommended by a physician; or alcoholism or drug addiction. AB does not pay for confi nements in any care unit that does not qualify as a hospital intensive care unit. Progressive care units, sub-acute intensive care units, intermediate care units, and private rooms with monitoring, step-down units and any other lesser care treatment units do not qualify as hospital intensive care units. We do not pay for step-down hospital intensive care unit confi nement if a covered person is admitted and confi ned in the following type of units: telemetry or surgical recovery rooms; post-anesthesia care units, progressive care units; intermediate care units; private monitored rooms; observation units located in emergency rooms or outpatient surgery units; beds, wards, or private or semi-private rooms with or without telemetry monitoring equipment; an emergency room; labor or delivery rooms; or other facilities that do not meet the standards for a step-down hospital intensive care unit. We do not pay this benefi t for continuous hospital intensive care unit confi nements or continuous step-down hospital intensive care unit confi nements that occur during a hospitalization that begins before the effective date of coverage. Coverage Subject to the Policy - The coverage described in the certifi cate of insurance is subject in every way to the terms of the policy that is issued to the policyholder (your employer). It alone makes up the agreement by which the insurance is provided. The group policy may at any time be amended or discontinued by agreement between AB and the policyholder. Your consent is not required for this. AB is not required to give you prior notice. Page 38

39 The policy is Limited Benefit Cancer and Specified Disease Insurance. The policy is not a Medicare Supplement Policy. If eligible for Medicare, review Medicare Supplement Buyer s Guide available from American Heritage Life Insurance Company. Subject to COBRA continuation of coverage. The coverage is provided by a limited benefit supplemental insurance policy. This material is valid as long as information remains current, but in no event later than August 1, Group Cancer and Specifi ed Disease benefi ts provided by policy GVCP3, or state variations thereof. The policy is underwritten by American Heritage Life Insurance Company. This brochure highlights some features of the policy but is not the insurance contract. Only the actual policy provisions control. The policy sets forth, in detail, the rights and obligations of both the policyholder (employer) and the insurance company. For complete details, contact your Insurance Agent, or call This is a brief overview of the benefi ts available under the Group Voluntary Policy underwritten by American Heritage Life Insurance Company. Details of the insurance, including exclusions, restrictions and other provisions are included in the certifi cate issued. This information is for use in enrollments which are sitused in North Carolina. Allstate Benefits is the marketing name used by American Heritage Life Insurance Company (Home Office, Jacksonville, FL), the underwriting company and a subsidiary of The Allstate Corporation. Allstate Benefits The Workplace Marketer 1776 American Heritage Life Drive, Jacksonville, Florida Customer Care Center: Customer Claims : or allstateatwork.com. Page 39

40 Aflac Personal Accident Indemnity Plan Accident-Only Insurance Level 2 Policy A NC Effective Date: August 1, 2012 Aflac insurance policies are subject to health underwriting. Plan Benefits Emergency Treatment Follow-Up Treatment Initial Hospitalization Hospital Confi nement Physical Therapy Accidental-Death Wellness Plus... much more ACCIDENT EMERGENCY TREATMENT BENEFIT Aflac will pay $120 if a covered person receives treatment for injuries sustained in a covered accident. This benefi t is payable for X-rays, treatment by a physician, or treatment received in a hospital emergency room. Treatment must be received within 72 hours of the accident for benefi ts to be payable. This benefi t is payable once per 24-hour period and only once per covered accident, per covered person. ACCIDENT FOLLOW-UP TREATMENT BENEFIT Aflac will pay $35 for one treatment per day for up to a maximum of six treatments per covered accident, per covered person for follow-up treatment received for injuries sustained in a covered accident. Treatment must begin within 30 days of the covered accident or discharge from the hospital. Treatments must be furnished by a physician in a physician s offi ce or in a hospital on an outpatient basis. This benefi t is not payable for the same visit that the Physical Therapy Benefi t is paid. INITIAL ACCIDENT HOSPITALIZATION BENEFIT Aflac will pay $1,300 when a covered person is confined to a hospital for at least 24 hours for injuries sustained in a covered accident. If the covered person is admitted directly to an intensive care unit, Aflac will pay $2,600. This benefi t is payable only once per hospital confi nement* or intensive care unit confi nement and is payable only once per calendar year, per covered person. ACCIDENT HOSPITAL CONFINEMENT BENEFIT Aflac will pay $325 per day for which a covered person is charged for a room for hospital confi nement* of at least 18 hours for treatment of injuries sustained in a covered accident. This benefi t is payable up to 365 days per covered accident, per covered person. The Accident Hospital Confi nement Benefi t and the Rehabilitation Unit Benefi t will not be paid on the same day; only the highest eligible benefi t will be paid. *Hospital confi nement is defined as a covered person s confi nement to a bed in a hospital for which a room charge is made. The confinement must be on the advice of a physician and medically necessary. Benefi ts are also payable for confi nement in hospitals operated by or for the United States government. Confi nement must start within 30 days of the accident. Underwritten by: American Family Life Assurance Company of Columbus MMC /12 Page 40

41 INTENSIVE CARE UNIT CONFINEMENT BENEFIT Aflac will pay an additional $400 per day for each day a covered person is receiving the Accident Hospital Confinement Benefit and is confined to and charged for a room in an intensive care unit. This benefit is payable up to 15 days per covered accident, per covered person. The confi nement must be advised by a physician and medically necessary. Confi nements must start within 30 days of the accident. ACCIDENT SPECIFIC-SUM INJURIES BENEFIT Aflac will pay $35 $12,500 for: Dislocations Burns Skin Grafts Eye Injuries Lacerations Fractures Broken Teeth Comas Brain Concussions Paralysis Surgical Procedures Treatment must be performed on a covered person for injuries sustained in a covered accident. We will pay for no more than two dislocations per covered accident, per covered person. Dislocations must be diagnosed by a physician within 72 hours after the covered accident. Benefi ts are payable for only the fi rst dislocation of a joint. If a physician reduces a dislocation with local or no anesthesia, we will pay 25 percent of the amount shown for the closed reduction dislocation. A physician must treat burns within 72 hours after a covered accident. A total of 50 percent of the burn benefi t will be paid for one or more skin grafts. Lacerations requiring sutures must be repaired under the attendance of a physician within 72 hours after the covered accident. Fractures must be diagnosed by a physician by X-ray within 14 days after a covered accident. For chip fractures and other fractures not reduced by open or closed reduction, we will pay 25 percent of the benefit amount shown for the closed reduction. We will pay for no more than two fractures per covered accident, per covered person. We will pay no more than one benefi t for broken teeth per covered accident, per covered person. Coma duration must be at least seven days and must require intubation for respiratory assistance. Paralysis must result from spinal cord injuries that are received in a covered accident and that result in complete and total loss of use of two or more limbs for a period of at least 30 days, and the loss must be confirmed by a physician. Surgical procedures must be performed within one year of a covered accident. Two or more surgical procedures performed through the same incision will be considered one operation, and benefi ts will be paid based upon the most expensive procedure. Only one miscellaneous surgery benefi t is payable per 24-hour period even though more than one procedure may be performed. MAJOR DIAGNOSTIC EXAMS BENEFIT Aflac will pay $200 if a covered person requires one of the following exams for injuries sustained in a covered accident: CT (computerized tomography) scan, MRI (magnetic resonance imaging), or EEG (electroencephalogram). The exam must be performed in a hospital, a physician s offi ce, or an ambulatory surgical center, and a charge must be incurred. This benefi t is limited to one payment per calendar year, per covered person. No lifetime maximum. Page 41

42 PHYSICAL THERAPY BENEFIT Aflac will pay $35 for one treatment per day up to a maximum of ten treatments per covered accident, per covered person if a physician advises the person to seek treatment from a physical therapist. Physical therapy must be for injuries sustained in a covered accident and must start within 30 days of the covered accident or discharge from the hospital. Treatment must take place within six months after the accident. This benefi t is not payable for the same visit that the Accident Follow-Up Treatment Benefi t is paid. REHABILITATION UNIT BENEFIT Aflac will pay $150 per day when a covered person is charged for confi nement in a hospital and transferred to a bed in a rehabilitation unit of a hospital for a covered injury. This benefit is limited to 30 days for each covered person per period of hospital confi nement and is limited to a calendar year maximum of 60 days. The Accident Hospital Confi nement Benefit and the Rehabilitation Unit Benefi t will not be paid on the same day; only the highest eligible benefi t will be paid. No lifetime maximum. A period of hospital confi nement is a time period of confi nement that starts while the policy is in force. If the confinement follows a previously covered confi nement, it will be deemed a continuation of the fi rst unless it is the result of an entirely unrelated injury or the confi nements are separated by 30 days or more. APPLIANCES BENEFIT Aflac will pay $125 if a covered person requires, as advised by a physician, the use of a medical appliance as an aid in personal locomotion resulting from injuries sustained in a covered accident. This benefi t is payable for crutches, wheelchairs, leg braces, back braces, and walkers, and is payable once per covered accident, per covered person. PROSTHESIS BENEFIT Aflac will pay $750 if a covered person requires a prosthetic device as a result of injuries sustained in a covered accident. This benefi t is payable once per covered accident, per covered person and is not payable for hearing aids, wigs, or dental aids, to include false teeth. BLOOD/PLASMA/PLATELETS BENEFIT Aflac will pay $200 if a covered person requires blood, plasma, or platelets for the treatment of injuries sustained in a covered accident. This benefi t is not payable for immunoglobulins and is payable only once per covered accident, per covered person. AMBULANCE BENEFIT Aflac will pay $200 for ground ambulance transportation or $1,500 for air ambulance transportation if a covered person requires ambulance transportation to a hospital or emergency center for injuries sustained in a covered accident. A licensed professional ambulance company must provide the transportation within 72 hours of the covered accident. TRANSPORTATION BENEFIT Aflac will pay $600 per round trip to a hospital if a covered person requires special treatment and hospital confi nement* for injuries sustained in a covered accident. Page 42

43 The hospital must be more than 100 miles from the covered person s residence or site of the accident. This benefit will be paid for only the covered person for whom the treatment is prescribed, or if the treatment is for a dependent child and commercial travel is necessary, one of the dependent child s parents or legal guardians who travels with the child will also receive this benefi t. The local attending physician must prescribe the treatment, and the treatment must not be available locally. This benefi t is payable for up to three round trips per calendar year, per covered person. This benefi t is not payable for transportation by ambulance or air ambulance to the hospital. FAMILY LODGING BENEFIT Aflac will pay $125 per night for one motel/hotel room for a member of the immediate family to accompany the covered person if treatment of injuries sustained in a covered accident requires hospital confi nement.* The hospital and motel/hotel must be more than 100 miles from the covered person s residence. This benefi t is payable up to 30 days per covered accident and only during the time the covered person is confi ned in the hospital. ACCIDENTAL-DEATH AND -DISMEMBERMENT BENEFITS Aflac will pay the following benefi t for death if it is the result of injuries sustained in a covered accident: Insured/Spouse Child Common-Carrier Accidents $ 150,000 $ 25,000 A covered person must be a passenger at the time of the common-carrier accident, and a proper authority must have licensed the vehicle to transport passengers for a fee. Common-carrier vehicles are limited to airplanes, trains, buses, trolleys, and boats that operate on a regularly scheduled basis between predetermined points or cities. Taxis are not included. Insured/Spouse Child Other Accidents $ 40,000 $ 12,500 (Other Accidents are accidents that are not classifi ed as common-carrier accidents and that are not specifi cally excluded in the limitations and exclusions of the policy.) Aflac will pay the following benefi t for dismemberment resulting from injuries sustained in a covered accident: Insured/Spouse Child Both arms and both legs $ 40,000 $ 12,500 Two eyes, feet, hands, arms, or legs $ 40,000 $ 12,500 One eye, foot, hand, arm, or leg $ 10,000 $ 3,750 One or more fingers and/or one or more toes $ 2,000 $ 625 Page 43

44 Death or dismemberment must be independent of disease, bodily infi rmity, or any other cause other than a covered accident and must occur within 90 days of the accident. Only the highest single benefit per covered person will be paid for accidental dismemberment. Benefi ts will be paid only once for any covered accident. If death and dismemberment result from the same accident, only the Accidental- Death Benefi t will be paid. Loss of use does not constitute dismemberment, except for eye injuries resulting in permanent loss of vision such that central visual acuity cannot be corrected to better than 20/200. WELLNESS BENEFIT After the policy has been in force for 12 months, Aflac will pay $60 if you or any one family member undergoes routine examinations or other preventive testing during the following policy year. Eligible family members are your spouse and the dependent children of you or your spouse. Services covered are annual physical examinations, dental exams, mammograms, Pap smears, eye examinations, immunizations, fl exible sigmoidoscopies, prostate-specifi c antigen tests (PSAs), ultrasounds, and blood screenings. This benefi t will become available following each anniversary of the policy s effective date for service received during the following policy year and is payable only once per policy each 12-month period following the policy anniversary date. Service must be under the supervision of or recommended by a physician and received while your policy is in force, and a charge must be incurred. CONTINUATION OF COVERAGE BENEFIT Afl ac will waive all monthly premiums due for the policy for up to two months if you meet all of the following conditions: (1) Your policy has been in force for at least six months; (2) We have received premiums for at least six consecutive months; (3) Your premiums have been paid through payroll deduction and you leave your employer for any reason; (4) You or your employer notifi es us in writing within 30 days of the date your premium payments cease because of your leaving employment; and (5) You re-establish premium payments, either through your new employer s payroll deduction process or direct payment to Afl ac. You will again become eligible for this benefi t after you re-establish your premium payments through payroll deduction for a period of at least six months, and we receive premiums for at least six consecutive months. (Payroll deduction means your premium is remitted to Afl ac for you by your employer through a payroll deduction process.) GUARANTEED-RENEWABLE The policy is guaranteed-renewable for your lifetime, subject to Afl ac s right to change premiums by class upon any renewal date. EFFECTIVE DATE The effective date of the policy is the date shown in the Policy Schedule, not the date the application is signed. The policy is available through age 64. The payroll rate may be retained after one month s premium payment on payroll deduction. Page 44

45 WHAT IS NOT COVERED We will not pay benefits for services rendered by you or a member of your immediate family, or for an accident that occurs while coverage is not in force. We will not pay benefi ts for an accident or sickness that is caused by or occurs as a result of a covered person s: Participating in any activity or event, including the operation of a vehicle, while under the infl uence of a controlled substance (unless administered by a physician and taken according to the physician s instructions) or while intoxicated (intoxicated means that condition as defi ned by the law of the jurisdiction in which the accident occurred); Driving any taxi for wage, compensation, or profi t; Mountaineering using ropes and/or other equipment, parachuting, or hang gliding; Participating in, or attempting to participate in, an illegal activity that is defi ned as a felony, whether charged or not (felony is as defi ned by the law of the jurisdiction in which the activity takes place); or being incarcerated in any type penal institution; Intentionally self-infl icting bodily injury or attempting suicide, while sane or insane; Having cosmetic surgery or other elective procedures that are not medically necessary, or having dental treatment except as a result of injury; Being exposed to war or any act of war, declared or undeclared; Actively serving in any of the armed forces, or units auxiliary thereto, including the National Guard or Army Reserve; Participating in any form of flight aviation other than as a fare-paying passenger in a fully licensed, passenger-carrying aircraft; Participating in any sport or sporting activity for wage, compensation, or profi t, including offi ciating or coaching, or racing any type vehicle in an organized event. A hospital does not include any institution or part thereof used as a rehabilitation unit; a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; an extended-care facility; a skilled nursing facility; or a facility primarily affording custodial or educational care, care or treatment for persons suffering from mental disease or disorders, care for the aged, or care for persons addicted to drugs or alcohol. FAMILY COVERAGE Family coverage includes the insured, spouse, and dependent children to age 26. Newborn children are automatically insured from the moment of birth. One-parent family coverage includes the insured and all dependent children to age 26. This includes your dependent children for whom you must provide medical support under a court or administrative order. Refer to the policy for complete details, limitations, and exclusions. This information is for illustration purposes only. Page 45

46 Aflac Personal Accident Indemnity Plan Accident-Only Insurance Level 2 Monthly Premium Rates Individual $19.40 Named Insured/Spouse Only $27.50 One-Parent Family $32.10 Two-Parent Family $40.70 Ten-Month Premium Rates Individual $23.28 Named Insured/Spouse Only $33.00 One-Parent Family $38.52 Two-Parent Family $ Pay Premium Rates Individual $11.64 Named Insured/Spouse Only $16.50 One-Parent Family $19.26 Two-Parent Family $24.42 Semimonthly Premium Rates Individual $9.70 Named Insured/Spouse Only $13.75 One-Parent Family $16.05 Two-Parent Family $20.35 The rates do not imply coverage. Refer to the policy for complete details, limitations, and exclusions. American Family Life Assurance Company of Columbus Worldwide Headquarters 1932 Wynnton Road Columbus, Georgia AFLAC ( ) En español: SI.AFLAC ( ) Visit our Web site at aflac.com. Page 46

47 Investment & Retirement Accounts 401(k) The NC 401(k) Plan is one of the best ways to save money for your retirement years and one of the few methods available today to defer current income taxes. Generally, a 401(k) feature allows you to decide what portion of your gross annual earnings you would like to contribute for retirement. Any contributions made by you are deducted from your pay before income taxes are taken out. In some cases, the ability to defer pre-tax contributions is not available since your employer makes all contributions to the 401(k) Plan on your behalf. However, you can still enjoy all the benefi ts of participating in the NC 401(k) plan including: a variety of investment options, world class customer service, online retirement planning tools, and GoalMakerSM, a free asset allocation service. 403 (B) & 457 Deferred Compensation Plan For plan information, contact Great American Plan Administrators, Inc. toll free at Page 47

48 AUL Short-Term Disability Plan Effective Date: August 1, 2012 Why do you need Disability Insurance? Consider this... Statistics show you are much more likely to be injured in an accident than to die from one. A fatal injury occurs every 5 minutes, and a disabling injury occurs every 1.5 seconds. 1 There is a death caused by a motor vehicle crash every 12 minutes; there is a disabling injury every 14 seconds. 1 In the home, there is a fatal injury every 16 minutes and a disabling injury every 4 seconds. 1 While many people survive accidental injuries, many others live with serious illnesses. In the United States, men have a little less than a 1-in-2 lifetime risk of developing cancer; for women the risk is a little more than 1-in-3. The fi ve-year relative survival rate for all cancers combined is 63%. 2 One in fi ve males and females has some form of cardiovascular disease. High blood pressure is the most common form of cardiovascular disease. 3 More than 35 million Americans are now living with chronic lung diseases, such as asthma, emphysema, and chronic bronchitis. 4 Advances in medicine are allowing us to live longer. However, recovery from a serious illness or injury often requires time away from work. In the last 20 years, deaths due to the big three (cancer, heart attack, and stroke) have gone down signifi cantly. But disabilities due to those same three are up dramatically! Things that use to kill now disable. 5 You have life insurance, home insurance, and automobile insurance. But is your income insured? 1 National Safety Council, Injury Facts, 2003 Edition 2 American Cancer Society, Cancer Facts & Figures American Heart Association, Heart Disease and Stroke Statistics 2004 Update 4 American Lung Association, Lung Disease Data National Underwriter, May 2002 Page 48

49 Class Description All Full-Time Eligible Employees working a minimum of 30 hours per week, electing to participate in the Voluntary Short Term Disability Insurance Disability You are considered disabled if, because of injury or sickness, you cannot perform the material and substantial duties of your regular occupation. You are not working in any occupation and are under the regular attendance of a Physician for that injury or sickness. Monthly Benefit You can choose to insure up to 70% your covered basic monthly earnings to a maximum monthly benefit of $2,000. The minimum benefit is $500. Elimination Period This means a period of time a disabled Employee must be out of work and totally disabled before weekly benefi ts begin; seven (7) consecutive days for a sickness and zero (0) days for injury. Benefit Duration This is the period of time that benefi ts will be payable for disability. You can choose a maximum STD benefi t duration, if continually disabled, of thirteen (13) weeks, twenty-six (26) weeks or fi fty-two (52) weeks. Basis of Coverage 24 hour coverage, on or off the job. Maternity Coverage Benefi ts will be paid the same as any other qualifying disability, subject to any applicable pre-existing condition exclusion. STD Pre-Existing Condition Exclusion 3/12, If a person receives medical treatment, or service or incurs expenses as a result of an Injury or Sickness within 3 months prior to the Individual Effective Date, then the Group Policy will not cover any Disability which is caused by, contributed to by, or resulting from that Injury or Sickness; and begins during the fi rst 12 months after the Person s Individual Effective Date. This Pre-Existing Condition limitation will be waived for all Persons who were included as part of the fi nal premium billing statement received by AUL/ OneAmerica from the prior carrier and will be Actively at work on the effective date. Page 49

50 Recurrent Disability If you resume Active Work for 30 consecutive workdays following a period of Disability for which the Weekly Benefi t was paid, any recurrent Disability will be considered a new period of Disability. A new Elimination Period must be completed before the Weekly Benefi t is payable. Exclusions and Limitations This plan will not cover any disability resulting from war, declared or undeclared or any act of war; active participation in a riot; intentionally self-infl icted injuries; commission of an assault or felony; or a pre-existing condition for a specifi ed time period. Portability Once an employee is on the AUL disability plan for 12 months, you may be eligible to port your coverage for one year at the same rate without evidence of insurability. You have 31 days from your date of termination to contact AUL and make application to port your coverage by calling Annual Enrollment Enrollees that did not elect coverage during their initial enrollment are eligible to sign up for $500 to $1000 monthly benefi t without medical questions. Current participants may increase their coverage up to $500 monthly benefi t without medical questions. The maximum benefit cannot exceed 70% of basic monthly earnings and must be in $100 increments. This information is provided as a summary of the product. It is not a part of the insurance contract and does not change or extend AUL s liability under the group policy. If there are any discrepancies between this information and the group policy, the group policy will prevail. Customer Service Disability Claims Fax: Disability Claims claims@disabilityrms.com Website: ts.aul.com Page 50

51 AUL Life Short-Term Disability 12 pay periods Benefit Duration: 13 Weeks Benefit Duration: 26 Weeks Benefit Duration: 52 Weeks Monthly Benefit Monthly Premium Monthly Benefit Monthly Premium Monthly Benefit Monthly Premium $500 $10.36 $500 $15.00 $500 $19.72 $600 $12.43 $600 $18.00 $600 $23.66 $700 $14.50 $700 $21.00 $700 $27.60 $800 $16.57 $800 $24.00 $800 $31.54 $900 $18.64 $900 $27.00 $900 $35.49 $1,000 $20.71 $1,000 $30.00 $1,000 $39.43 $1,100 $22.78 $1,100 $33.00 $1,100 $43.37 $1,200 $24.85 $1,200 $36.00 $1,200 $47.32 $1,300 $26.92 $1,300 $39.00 $1,300 $51.26 $1,400 $28.99 $1,400 $42.00 $1,400 $55.20 $1,500 $31.07 $1,500 $45.00 $1,500 $59.15 $1,600 $33.14 $1,600 $48.00 $1,600 $63.09 $1,700 $35.21 $1,700 $51.00 $1,700 $67.03 $1,800 $37.28 $1,800 $54.00 $1,800 $70.97 $1,900 $39.35 $1,900 $57.00 $1,900 $74.92 $2,000 $41.42 $2,000 $60.00 $2,000 $78.86 Page 51

52 AUL Life Short-Term Disability 10 pay periods Benefit Duration: 13 Weeks Benefit Duration: 26 Weeks Benefit Duration: 52 Weeks Monthly Benefit Tenthly Premium Monthly Benefit Tenthly Premium Monthly Benefit Tenthly Premium $500 $12.43 $500 $18.00 $500 $23.66 $600 $14.91 $600 $21.60 $600 $28.39 $700 $17.40 $700 $25.20 $700 $33.12 $800 $19.88 $800 $28.80 $800 $37.85 $900 $22.37 $900 $32.40 $900 $42.58 $1,000 $24.85 $1,000 $36.00 $1,000 $47.32 $1,100 $27.34 $1,100 $39.60 $1,100 $52.05 $1,200 $29.82 $1,200 $43.20 $1,200 $56.78 $1,300 $32.31 $1,300 $46.80 $1,300 $61.51 $1,400 $34.79 $1,400 $50.40 $1,400 $66.24 $1,500 $37.28 $1,500 $54.00 $1,500 $70.97 $1,600 $39.76 $1,600 $57.60 $1,600 $75.71 $1,700 $42.25 $1,700 $61.20 $1,700 $80.44 $1,800 $44.73 $1,800 $64.80 $1,800 $85.17 $1,900 $47.22 $1,900 $68.40 $1,900 $89.90 $2,000 $49.70 $2,000 $72.00 $2,000 $94.63 Page 52

53 AUL Life Short-Term Disability 20 pay periods Benefit Duration: 13 Weeks Benefit Duration: 26 Weeks Benefit Duration: 52 Weeks Monthly Benefit 20 Pay Premium Monthly Benefit 20 Pay Premium Monthly Benefit 20 Pay Premium $500 $6.22 $500 $9.00 $500 $11.83 $600 $7.46 $600 $10.80 $600 $14.20 $700 $8.70 $700 $12.60 $700 $16.56 $800 $9.94 $800 $14.40 $800 $18.93 $900 $11.19 $900 $16.20 $900 $21.29 $1,000 $12.43 $1,000 $18.00 $1,000 $23.66 $1,100 $13.67 $1,100 $19.80 $1,100 $26.03 $1,200 $14.91 $1,200 $21.60 $1,200 $28.39 $1,300 $16.16 $1,300 $23.40 $1,300 $30.76 $1,400 $17.40 $1,400 $25.20 $1,400 $33.12 $1,500 $18.64 $1,500 $27.00 $1,500 $35.49 $1,600 $19.88 $1,600 $28.80 $1,600 $37.86 $1,700 $21.13 $1,700 $30.60 $1,700 $40.22 $1,800 $22.37 $1,800 $32.40 $1,800 $42.59 $1,900 $23.61 $1,900 $34.20 $1,900 $44.95 $2,000 $24.85 $2,000 $36.00 $2,000 $47.32 Page 53

54 AUL Life Short-Term Disability 24 pay periods Benefit Duration: 13 Weeks Monthly Benefit Semi- Monthly Premium Benefit Duration: 26 Weeks Monthly Benefit Semi- Monthly Premium Benefit Duration: 52 Weeks Monthly Benefit Semi- Monthly Premium $500 $5.18 $500 $7.50 $500 $9.86 $600 $6.22 $600 $9.00 $600 $11.83 $700 $7.25 $700 $10.50 $700 $13.80 $800 $8.29 $800 $12.00 $800 $15.77 $900 $9.32 $900 $13.50 $900 $17.75 $1,000 $10.36 $1,000 $15.00 $1,000 $19.72 $1,100 $11.39 $1,100 $16.50 $1,100 $21.69 $1,200 $12.43 $1,200 $18.00 $1,200 $23.66 $1,300 $13.46 $1,300 $19.50 $1,300 $25.63 $1,400 $14.50 $1,400 $21.00 $1,400 $27.60 $1,500 $15.54 $1,500 $22.50 $1,500 $29.58 $1,600 $16.57 $1,600 $24.00 $1,600 $31.55 $1,700 $17.61 $1,700 $25.50 $1,700 $33.52 $1,800 $18.64 $1,800 $27.00 $1,800 $35.49 $1,900 $19.68 $1,900 $28.50 $1,900 $37.46 $2,000 $20.71 $2,000 $30.00 $2,000 $39.43 Page 54

55 Continental American Insurance Group Critical Illness Plan Effective Date: August 1, 2012 Group Critical Illness Benefits First Occurrence Benefit After the Waiting Period, an insured may receive up to 100% of the benefi t selected upon the fi rst diagnosis of each covered critical illness. Covered Critical Illnesses* Illnesses Covered Under Plan Percentage of Face Amount Heart Attack 100% Stroke 100% Major Organ Transplant 100% Kidney Failure (End Stage) 100% Coronary Artery Bypass Surgery** 25% *At age 70, benefi ts are reduced by 50%. **Payment of the partial benefi t for Coronary Artery Bypass Surgery will reduce by 25% the benefi t for a Heart Attack. Additional Occurrence Benefit If an insured collects full benefi ts for a Critical Illness under the plan and later has one of the remaining covered illnesses, then we will pay the full benefi t amount for any additional illness. Occurrences must be separated by at least 6 months. Re-Occurrence Benefits We will pay benefi ts for the re-occurrence of any one Critical Illness once every twelve months. Therefore, once benefi ts have been paid for Critical Illness, no additional benefi ts are payable for that same Critical Illness unless the dates of diagnosis are separated by at least 12 months. Page 55 AG /12

56 Health Screening Benefits After the Waiting Period, an insured may receive a maximum of $100 for any one covered screening test per calendar year. We will pay this benefi t regardless of the results of the test. Payment of this benefi t will not reduce the amount payable for the diagnosis of a critical illness. There is no limit to the number of years the insured can receive the health screening benefi t; it will be paid as long as the policy remains inforce. This benefi t is payable for the covered employee and spouse. This benefi t is not paid for dependent children. The covered health screening tests include but are not limited to: Stress test on a bicycle or treadmill Flexible sigmoidoscopy Fasting blood glucose test, blood test for Hemocult stool analysis triglycerides or serum cholesterol test to Mammography determine level of HDL and LDL Pap smear Bone marrow testing PSA (blood test for prostate cancer) Breast ultrasound Serum protein electrophoresis CA 15-3 (blood test for breast cancer) (blood test for myeloma) CA 125 (blood test for ovarian cancer) Thermography CEA (blood test for colon cancer) Chest x-ray Colonoscopy Additional Specified Critical Illness Rider Additional (Covered) Specifi ed Critical Illnesses* Illness Covered Under Plan Percentage of Maximum Benefi t Coma 100% Paralysis 100% Burns 100% Loss Sight 100% Loss of Hearing 100% Loss of Speech 100% * At age 70, benefits are reduced by 50% Page 56

57 We will pay the indicated percentages of the applicable Maximum Benefi t Amount shown in the Certifi cate Schedule. Benefi ts are not payable for loss if these conditions result from another Specifi ed Critical Illness. The Dates of Loss for Specifi ed Critical Illnesses must be separated by at least 6 months for benefi ts to be payable for multiple Specifi ed Critical Illnesses. Heart Benefit Rider Illnesses Covered Under Plan Covered Surgeries & Procedures* Category 1 Percentage of Face Amount Coronary artery bypass surgery 100% Mitral valve replacement or repair 100% Aortic valve replacement or repair 100% Surgical Treatment of Abdominal aortic aneurysm 100% Category 2** AngioJet Clot Busting 10% Balloon Angioplasty (or Balloon valvuloplasty) 10% Laser Angioplasty 10% Atherectomy 10% Stent Implantation 10% Cardiac catheterization 10% Automatic Implantable (or Internal) Cardioverter Defi brillator (ACID) 10% Pacemakers 10% * At age 70, benefits are reduced by 50%. We will pay the indicated percentages of the applicable Initial Maximum Benefi t amount shown in the Rider Schedule that occurs while this Rider is in force. Benefi ts are not payable under this Rider for loss if these conditions result from another Specifi ed Critical Illness. Page 57

58 ** Benefi ts for Category II will reduce the benefi t amounts payable for Category I benefi ts. Benefi ts will be paid only at the highest benefi t level. If a Cat I and II are performed at the same time, benefi ts are only eligible at the 100% (higher) event and will not exceed the amount Initial Face Amount shown on the Rider Schedule. You are only eligible to receive one payment for each benefi t category listed on the schedule page. The Dates of Loss for Covered Procedures must be separated by at least 6 months for benefi ts to be payable for multiple Covered Procedures. Subject to the re-occurrence benefi t in the base plan, only one Category II benefi t is payable. Benefi ts will not be paid for multiple procedures listed under the Category II benefi t. Individual Eligibility All full-time and part time employees working at least 30 hours or more weekly with at least 90 days of employment. If an employee is eligible, their spouse is eligible for coverage and all children of the insured who are natural children, stepchildren, foster children, legally adopted children or children placed for adoption, who are under age 26. Issue age is between for employees and spouses. Seasonal and temporary workers are not eligible to participate. Spouse Coverage Available The employee may elect to purchase spouse coverage. In order to apply for spouse coverage, the employee must also apply. The spouse amount may not exceed 50% of the employee amount, subject to the minimum face amount of $5,000. If the employee does not meet the underwriting requirements necessary to participate in the plan, the spouse can still obtain coverage. The spouse would then become the primary insured and is limited to face amounts between $5,000 and $25,000. Dependent Children Coverage at No Additional Charge Each eligible dependent child is covered at 25 percent of the primary insured amount at no additional charge. We will not pay 25% of the primary insured amount more than once for the same covered critical illness. The payment of benefi ts for a dependent child does not reduce the face amount of the primary insured. Child coverage would end when benefi ts for the last remaining adult insured is paid in full. Children-only coverage is not available. Portability When coverage would otherwise terminate because the employee ends employment with the employer, coverage may be continued. The employee will continue the coverage that is inforce on the date employment ends, including dependent coverage then in effect. The employee must contact CAIC within 30 days of the date employment ends to take advantage of the portability option. The employee will be allowed to continue the coverage until the earlier of the date the employee fails to pay the required premium or the date the group master policy is terminated. Coverage may not be continued if the employee fails to pay any required premium or the group master policy terminates. Page 58

59 If this coverage will replace any existing individual policy please be aware that it may be in your best interest to maintain your individual guaranteed-renewable policy. Exceptions and Reductions (also applies to Additional Specified Critical Illnesses and Heart Benefits) This plan contains a 30-day waiting period. This means that no benefi ts are payable for any insured before coverage has been in force 30 days from their effective date of coverage. If an insured is fi rst diagnosed during the waiting period, benefi ts for that Critical Illness will apply only to loss commencing after 12 months from the effective date of coverage, or the employee may elect to void the certifi cate from the beginning and receive a full refund of premium. The date of diagnosis of a Critical Illness must be separated from the date of diagnosis of a subsequent different Critical Illness by at least 6 months. The date of diagnosis of the same Critical Illness must be separated from the date of diagnosis of the subsequent same Critical Illness by at least 12 months. The applicable benefi t amount will be paid if: the date of diagnosis is after the waiting period; the date of diagnosis occurs while the policy and certifi cate are in force; and the cause of the illness is not excluded by name or specifi c description. Benefi ts will not be paid for loss due to: 1. Intentionally self-infl icted injury or action; 2. Suicide or attempted suicide while sane or insane; 3. Illegal activities or participation in an illegal occupation; 4. War, whether declared or undeclared or military confl icts, participation in an insurrection or riot, civil commotion or state of belligerence; 5. Substance abuse; or 6. Pre-existing conditions. Diagnosis must be made and treatment received in the United States. Pre-existing Conditions Limitation & Exceptions Pre-existing Condition means a sickness or physical condition which, within the 12-month period prior to an insured s effective date resulted in the insured receiving medical advice or treatment. We will not pay benefi ts for any condition or illness starting within 12 months of an insured s effective date which is caused by, contributed to, or resulting from a pre-existing condition. A claim for benefi ts for loss starting after 12 months from the effective date will not be reduced or denied on the grounds that it is caused by a pre-existing condition. A condition will no longer be considered pre-existing at the end of 12 consecutive months starting and ending after an insured s effective date. Additional Benefit Rider Exceptions and Reductions: No Benefi ts will be paid for loss which occurred prior to the effective date of the Page 59

60 Heart Benefit Rider Exceptions: All limitations and exclusions that apply to the Critical Illness plan also apply to this rider. The Waiting Period and Pre-existing condition limitation apply from the date of this rider is effective. Any Benefi ts for Coronary Artery Bypass Surgery denied under this rider due to pre-existing conditions may be paid at the reduced benefi t amount under the certifi cate, subject to the terms of the certifi cate. No benefi ts will be paid for loss which occurred prior to the effective date of this Rider. Actively At Work Requirement If you are not Actively at Work on the last scheduled work day coincident with or preceding the date your insurance would otherwise become effective, insurance will not be effective until the date you return to and remain Actively at Work. If an eligible Spouse or Dependent Child is unable to engage in the normal activities of a person in good health of like age and sex on the date this Rider would otherwise become effective, coverage will not be effective until the date such person is able to engage in the normal activities of a person in good health of like age and sex. This will not apply to an eligible Dependant Child who is incapable of self-sustaining employment by reason of mental or physical incapacity, and who is primarily dependent on the Insured for support and maintenance. Underwriting Guidelines Guaranteed Issue Guaranteed Issue $10,000 for Employee and 5,000 Spouse Guaranteed Issue with 100 applications & 10% participation $20,000 for Employee and 10,000 Spouse Guaranteed Issue with 20 % participation Modified Guaranteed Issue For employee amounts of $50,000 or less, and spouse amounts of $25,000 or less: 1. Have you ever been treated for or diagnosed by a member of the medical profession for Acquired Immune Defi ciency Syndrome (AIDS) or AIDS Related Complex (ARC) or ever tested positive for antigens or antibodies to an AIDS virus? 2. In the last 7 years have you been treated for or diagnosed with cancer or any malignancy, which includes carcinoma, sarcoma, Hodgkin s Disease, leukemia, lymphoma, or malignant tumor? Cancer does not include basal cell or squamous cell carcinoma. 3. Have you ever been treated for or diagnosed with a) a stroke, a heart attack, a heart condition, heart trouble, or any abnormality of the heart (including artery Page 60

61 disease), diabetes, or any liver disorder; b) kidney (renal failure) or end stage kidney (renal) disease; c) organ transplant; d)emphysema or e) now taking 3 or more medications for high blood pressure? These questions are knockout questions. Any yes response results in a declination. If participation requirements are met, employees who would otherwise be declined will be issued the lesser of the amount applied for or the guaranteed issue limit. Underwritten by: Continental American Insurance Company (CAIC) is a wholly-owned subsidiary of Afl ac Incorporated. CAIC underwrites group coverage but is not licensed to solicit business in Guam, Puerto Rico, or the Virgin Islands. In California, group coverage is underwritten by Continental American Life Insurance Company, and in New York group coverage is underwritten by American Family Life Assurance Company of New York Devine Street, Columbia, South Carolina Customer Service Website: csc@caicworksite.com Page 61

62 CAIC Group Critical Illness Plan - 12 pay periods Employee Rates Non-Tobacco AGE $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $5.35 $7.20 $9.05 $10.90 $12.75 $14.60 $16.45 $18.30 $20.15 $ $6.55 $9.60 $12.65 $15.70 $18.75 $21.80 $24.85 $27.90 $30.95 $ $9.70 $15.90 $22.10 $28.30 $34.50 $40.70 $46.90 $53.10 $59.30 $ $13.45 $23.40 $33.35 $43.30 $53.25 $63.20 $73.15 $83.10 $93.05 $ $19.50 $35.50 $51.50 $67.50 $83.50 $99.50 $ $ $ $ Tobacco AGE $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $6.30 $9.10 $11.90 $14.70 $17.50 $20.30 $23.10 $25.90 $28.70 $ $8.35 $13.20 $18.05 $22.90 $27.75 $32.60 $37.45 $42.30 $47.15 $ $15.80 $28.10 $40.40 $52.70 $65.00 $77.30 $89.60 $ $ $ $23.15 $42.80 $62.45 $82.10 $ $ $ $ $ $ $34.10 $64.70 $95.30 $ $ $ $ $ $ $ Spouse Rates *Spouse coverage may not exceed 50% of Employee s elected amount Example: If an Employee elects $30,000 of coverage, the Spouse coverage may not exceed $15,000 Non-Tobacco $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $5.35 $6.28 $7.20 $8.13 $9.05 $9.98 $10.90 $11.83 $ $6.55 $8.08 $9.60 $11.13 $12.65 $14.18 $15.70 $17.23 $ $9.70 $12.80 $15.90 $19.00 $22.10 $25.20 $28.30 $31.40 $ $13.45 $18.43 $23.40 $28.38 $33.35 $38.33 $43.30 $48.28 $ $19.50 $27.50 $35.50 $43.50 $51.50 $59.50 $67.50 $75.50 $83.50 Tobacco AGES $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $6.30 $7.70 $9.10 $10.50 $11.90 $13.30 $14.70 $16.10 $ $8.35 $10.78 $13.20 $15.63 $18.05 $20.48 $22.90 $25.33 $ $15.80 $21.95 $28.10 $34.25 $40.40 $46.55 $52.70 $58.85 $ $23.15 $32.98 $42.80 $52.63 $62.45 $72.28 $82.10 $91.93 $ $34.10 $49.40 $64.70 $80.00 $95.30 $ $ $ $ Page 62

63 CAIC Group Critical Illness Plan - 10 pay periods Employee Rates Non-Tobacco AGE $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $6.42 $8.64 $10.86 $13.08 $15.30 $17.52 $19.74 $21.96 $24.18 $ $7.86 $11.52 $15.18 $18.84 $22.50 $26.16 $29.82 $33.48 $37.14 $ $11.64 $19.08 $26.52 $33.96 $41.40 $48.84 $56.28 $63.72 $71.16 $ $16.14 $28.08 $40.02 $51.96 $63.90 $75.84 $87.78 $99.72 $ $ $23.40 $42.60 $61.80 $81.00 $ $ $ $ $ $ Tobacco AGE $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $7.56 $10.92 $14.28 $17.64 $21.00 $24.36 $27.72 $31.08 $34.44 $ $10.02 $15.84 $21.66 $27.48 $33.30 $39.12 $44.94 $50.76 $56.58 $ $18.96 $33.72 $48.48 $63.24 $78.00 $92.76 $ $ $ $ $27.78 $51.36 $74.94 $98.52 $ $ $ $ $ $ $40.92 $77.64 $ $ $ $ $ $ $ $ Spouse Rates *Spouse coverage may not exceed 50% of Employee s elected amount Example: If an Employee elects $30,000 of coverage, the Spouse coverage may not exceed $15,000 Non-Tobacco $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $6.42 $7.53 $8.64 $9.75 $10.86 $11.97 $13.08 $14.19 $ $7.86 $9.69 $11.52 $13.35 $15.18 $17.01 $18.84 $20.67 $ $11.64 $15.36 $19.08 $22.80 $26.52 $30.24 $33.96 $37.68 $ $16.14 $22.11 $28.08 $34.05 $40.02 $45.99 $51.96 $57.93 $ $23.40 $33.00 $42.60 $52.20 $61.80 $71.40 $81.00 $90.60 $ Tobacco AGES $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $7.56 $9.24 $10.92 $12.60 $14.28 $15.96 $17.64 $19.32 $ $10.02 $12.93 $15.84 $18.75 $21.66 $24.57 $27.48 $30.39 $ $18.96 $26.34 $33.72 $41.10 $48.48 $55.86 $63.24 $70.62 $ $27.78 $39.57 $51.36 $63.15 $74.94 $86.73 $98.52 $ $ $40.92 $59.28 $77.64 $96.00 $ $ $ $ $ Page 63

64 CAIC Group Critical Illness Plan - 20 Pay Periods Employee Rates Non-Tobacco AGE $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $3.21 $4.32 $5.43 $6.54 $7.65 $8.76 $9.87 $10.98 $12.09 $ $3.93 $5.76 $7.59 $9.42 $11.25 $13.08 $14.91 $16.74 $18.57 $ $5.82 $9.54 $13.26 $16.98 $20.70 $24.42 $28.14 $31.86 $35.58 $ $8.07 $14.04 $20.01 $25.98 $31.95 $37.92 $43.89 $49.86 $55.83 $ $11.70 $21.30 $30.90 $40.50 $50.10 $59.70 $69.30 $78.90 $88.50 $98.10 Tobacco AGE $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $3.78 $5.46 $7.14 $8.82 $10.50 $12.18 $13.86 $15.54 $17.22 $ $5.01 $7.92 $10.83 $13.74 $16.65 $19.56 $22.47 $25.38 $28.29 $ $9.48 $16.86 $24.24 $31.62 $39.00 $46.38 $53.76 $61.14 $68.52 $ $13.89 $25.68 $37.47 $49.26 $61.05 $72.84 $84.63 $96.42 $ $ $20.46 $38.82 $57.18 $75.54 $93.90 $ $ $ $ $ Spouse Rates *Spouse coverage may not exceed 50% of Employee s elected amount Example: If an Employee elects $30,000 of coverage, the Spouse coverage may not exceed $15,000 Non-Tobacco $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $3.21 $3.77 $4.32 $4.88 $5.43 $5.99 $6.54 $7.10 $ $3.93 $4.85 $5.76 $6.68 $7.59 $8.51 $9.42 $10.34 $ $5.82 $7.68 $9.54 $11.40 $13.26 $15.12 $16.98 $18.84 $ $8.07 $11.06 $14.04 $17.03 $20.01 $23.00 $25.98 $28.97 $ $11.70 $16.50 $21.30 $26.10 $30.90 $35.70 $40.50 $45.30 $50.10 Tobacco AGES $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $3.78 $4.62 $5.46 $6.30 $7.14 $7.98 $8.82 $9.66 $ $5.01 $6.47 $7.92 $9.38 $10.83 $12.29 $13.74 $15.20 $ $9.48 $13.17 $16.86 $20.55 $24.24 $27.93 $31.62 $35.31 $ $13.89 $19.79 $25.68 $31.58 $37.47 $43.37 $49.26 $55.16 $ $20.46 $29.64 $38.82 $48.00 $57.18 $66.36 $75.54 $84.72 $93.90 Page 64

65 CAIC Group Critical Illness Plan - 24 Pay Periods Employee Rates Non-Tobacco AGE $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $2.68 $3.60 $4.53 $5.45 $6.38 $7.30 $8.23 $9.15 $10.08 $ $3.28 $4.80 $6.33 $7.85 $9.38 $10.90 $12.43 $13.95 $15.48 $ $4.85 $7.95 $11.05 $14.15 $17.25 $20.35 $23.45 $26.55 $29.65 $ $6.73 $11.70 $16.68 $21.65 $26.63 $31.60 $36.58 $41.55 $46.53 $ $9.75 $17.75 $25.75 $33.75 $41.75 $49.75 $57.75 $65.75 $73.75 $81.75 Tobacco AGE $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50, $3.15 $4.55 $5.95 $7.35 $8.75 $10.15 $11.55 $12.95 $14.35 $ $4.18 $6.60 $9.03 $11.45 $13.88 $16.30 $18.73 $21.15 $23.58 $ $7.90 $14.05 $20.20 $26.35 $32.50 $38.65 $44.80 $50.95 $57.10 $ $11.58 $21.40 $31.23 $41.05 $50.88 $60.70 $70.53 $80.35 $90.18 $ $17.05 $32.35 $47.65 $62.95 $78.25 $93.55 $ $ $ $ Spouse Rates *Spouse coverage may not exceed 50% of Employee s elected amount Example: If an Employee elects $30,000 of coverage, the Spouse coverage may not exceed $15,000 Non-Tobacco $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $2.68 $3.14 $3.60 $4.06 $4.53 $4.99 $5.45 $5.91 $ $3.28 $4.04 $4.80 $5.56 $6.33 $7.09 $7.85 $8.61 $ $4.85 $6.40 $7.95 $9.50 $11.05 $12.60 $14.15 $15.70 $ $6.73 $9.21 $11.70 $14.19 $16.68 $19.16 $21.65 $24.14 $ $9.75 $13.75 $17.75 $21.75 $25.75 $29.75 $33.75 $37.75 $41.75 Tobacco AGES $5,000 $7,500 $10,000 $12,500 $15,000 $17,500 $20,000 $22,500 $25, $3.15 $3.85 $4.55 $5.25 $5.95 $6.65 $7.35 $8.05 $ $4.18 $5.39 $6.60 $7.81 $9.03 $10.24 $11.45 $12.66 $ $7.90 $10.98 $14.05 $17.13 $20.20 $23.28 $26.35 $29.43 $ $11.58 $16.49 $21.40 $26.31 $31.23 $36.14 $41.05 $45.96 $ $17.05 $24.70 $32.35 $40.00 $47.65 $55.30 $62.95 $70.60 $78.25 Page 65

66 Lincoln Financial Term Life Plan Effective Date - when approved by Lincoln Financial All Evidence of Insurability are subject to underwriting approval VOLUNTARY EMPLOYEE LIFE INSURANCE This insurance is payable for death from any cause to any person you name as benefi ciary. Your Voluntary Life coverage provides important protection for you as well as your family. VOLUNTARY DEPENDENT LIFE INSURANCE Provides coverage on: Your Spouse Child(ren) from 14 days of age to age 19 (to age 25 if unmarried, wholly dependent upon you for maintenance and support and if enrolled as a full-time student in an accredited school or college). Handicapped children can continue to be covered with no age limit. NOTE: It is your responsibility to notify Human Resources when a dependent is ineligible for coverage. Examples of ineligible dependent status are divorce, death, or a child is 19 years of age and not in college. A child can be covered to age 25 if a full-time unmarried, student and dependent upon you for maintenance and support. FEATURES The plan features easy eligibility and simple enrollment procedures AND...there is no need for a medical exam if you sign up during the enrollment period and you meet the eligibility criteria. Furthermore, automatic payroll deductions simplify paperwork. This means less bookkeeping for you and no worries about a lapse in coverage due to missed payments. LOW COST Your cost is lower than for comparable insurance on an individual basis due to the wholesale economies inherent in group insurance. Additionally, the System absorbs the cost of administering the program which is underwritten by Lincoln Financial Group. ELIGIBILITY You will be eligible for this plan if you are a full-time active employee working 30 hours or more per week. ENROLLMENT Enrollment is simple- just fi ll out the enrollment form provided by your Employer. Make sure you supply all the required information and return the form where you work.that s all. You will be notifi ed as to when coverage starts. BENEFICIARY You have the right to designate the benefi ciary of your choice under Employee coverage. Normally you are the benefi ciary under Dependent Life unless you specify otherwise. Page 66

67 REDUCTIONS AT AGE 70 & OVER If you remain in active service beyond age 70 your Voluntary Employee Life Insurance will reduce as follows: Attained Age Coverage Will Reduce By 70 35% 75 20% 80 15% With respect to your dependent spouse, there would not be a reduction in coverage based on age; however, the coverage would end when that person reached the age of 70 if no other events have already ceased the coverage such as: your death, retirement, or when that person ceases to be your dependent. TERMINATION OF COVERAGE All insurance under this plan will terminate upon the earlier of retirement, termination of employment, when the plan ceases or when you withdraw from the plan. Nevertheless, if you should die within 31 days thereafter, your life insurance will still be paid to the benefi ciary. If any of your covered dependents should die within such 31 day period, the amount of Life Insurance on account of such dependent will be paid to you. CONVERSION You must apply and pay the premium for the converted policy within 31 days of your group life insurance ending. If the policy ends or is changed to reduce or end your life insurance, and if you have been insured for at least 5 years under the policy, you may convert up to the lesser of: $10,000 or the amount of life insurance that ended minus the amount of any group life insurance for which you become eligible within 31 days. PREMIUM PAYMENT Premium payments must continue until: (1) the day the Insured Person is approved for this Extension of Death Benefi t; or (2) the day this Policy terminates (whichever is fi rst) AMOUNT CONTINUED (1) will be the amount of Voluntary Life Insurance and any Dependent Life Insurance in effect on the day the Insured Person s Total Disability begins; and (2) will be subject to the reductions and terminations in effect under this Policy on that day. THE ACCLERATED BENEFIT OPTION (ABO) Lincoln Financial Group has included an Accelerated Benefi t Option (ABO) as part of your Group Life benefi ts. Under this option, if you are diagnosed as having a terminal illness, you will be eligible to receive a maximum of $250,000 or 75% (whichever is less) of your insurance coverage. Please refer to your Group Certifi cate for details. Page 67

68 SUICIDE EXCLUSION The Voluntary Term Life Insurance on any Insured Person will not be payable if the Person dies as a result of suicide within two years of the date his insurance becomes effective with Lincoln Financial, or prior insurer, and or after an election to increase the amount of insurance under the policy. Lincoln Financial Group s liability for that portion of insurance shall be limited to the return of premiums paid for the life insurance without interest. TERMINATION OF COVERAGE All insurance under this plan will terminate upon the earlier of the date you retire or the date your employment terminates. Nevertheless, if you or a covered dependent should die within 31 days thereafter, the life insurance will still be paid to the benefi ciary. CLAIMS PROCEDURE Claim forms needed to fi le for benefi ts under the group insurance program can be obtained from your Employer who will also be ready to assist in fi ling claims. The instructions on the claim form should be followed carefully. This will expedite the processing of the claim. Be sure all questions are answered fully. If there is any question about a claim payment, an explanation can be requested from your Employer, who is usually able to provide the necessary information. PLAN SPONSOR Cabarrus County Schools 4425 Old Airport Road Concord, NC Page 68

69 TravelConnectSM services just made travel easier As part of your employee benefits package, your Lincoln Financial Group life insurance coverage includes our TravelConnectSM program, an employee benefi t focusing on travel, medical, and safety-related services while traveling. Lincoln Financial has partnered with MEDEX Assistance Corporation, a worldwide leader in travel assistance, to make this valuable benefi t available to you and your immediate family. Business or leisure travel they re both covered. The Travel- ConnectSM benefi t is provided at no cost to you and includes a wealth of services when traveling just 100 miles or more from home. These services are provided for both business and leisure travel. Whether you simply want the weather forecast for your travel destination or need emergency medical assistance halfway around the world, MEDEX has the professional staff and resources to provide support, 24 hours a day, seven days a week. Feel free to use the services as much or as little as you need. Comprehensive coverage A sampling of the services: Destination info weather, currency, and more Emergency travel arrangements and funds transfer Lost or stolen travel documents assistance Language translation services Emergency medical evacuation and transportation Dependent child transportation if left unattended Medical and dental referrals Assistance with corrective lenses or medical device replacement Treatment monitoring of a medical situation Delivery of medications, vaccines, or blood arranged Updates to family, employer, and/or home physician Repatriation of a deceased traveler Security and political evacuation assistance Page 69

70 Travel assistance services are subject to specifi c terms, conditions, and limitations. A program description is available at c.com. To use TravelConnectSM services, call MEDEX at or and provide them with ID number TravelConnect SM services are provided through MEDEX Assistance Corporation in Towson, MD (in WA and OR underwritten by Arch Insurance Company, a Missouri corporation, NAIC #11150, with executive offi ces located in New York, NY), both are separate, independent contractors and are not affi liates of Lincoln Financial Group. Each independent company is solely responsible for its own obligations. Coverage is subject to actual policy language and specifi c terms, conditions, and limitations. A complete program description is available at www. exec-u-care.com. Page 70

71 SCHEDULE OF BENEFITS BASIC EMPLOYEE LIFE INSURANCE All Eligible Employees $5,000 (no cost to you) VOLUNTARY EMPLOYEE LIFE Your choice of the following amounts: $10,000, $20,000, $30,000, $40,000, $50,000, $60,000, $70,000, $80,000 $90,000, $100,000, $150,000, $200,000, $250,000 To be eligible for coverage above $50,000 you must furnish medical evidence of insurability satisfactory to Lincoln Financial. Guaranteed Issue amount: Under age 65 - $50, years of age- $20,000 Age None (must answer health questions) If you are an existing employee and you are increasing your current coverage amount or if you are applying for coverage the very first time (did not apply when first hired) you are required to complete an Evidence of Insurability. This applies to your dependents as well. VOLUNTARY DEPENDENT LIFE INSURANCE Spouse- $10,0000, $20,000, $30,000, $40,000, $50,000 on your spouse To be eligible for $20,000 coverage and above your spouse must furnish medical evidence of insurability and you must elect a minimum of $20,000 and above of coverage. Child(ren)- $5,000, $10,000, $15,000, $20,000, $25,000 on each of your eligible children* *per child (no matter how many children you have) Child 14 days old to 6 months has $250 coverage. Child from birth to 14 days does not have any life coverage. REMINDERS Voluntary Dependent Life Insurance is available only to those eligible Employees who are insured for Voluntary Employee Life Insurance. Any existing employee who applies for Term Life coverage for the first time (did not apply when first hired) or increases their current coverage will be required to complete an Evidence of Insurability (applies to dependents also). Any coverage amounts $50,000 and below will be pre-tax Any coverage amounts over $50,000 will be post-tax Page 71

72 12 pay periods Optional Employee Coverage Monthly Deduction Optional Spouse Coverage Monthly Deduction Optional Child Coverage Monthly Deduction $10,000 $1.90 $10,000 $5.60 $5,000 $1.00 $20,000 $3.80 $20,000 $11.20 $10,000 $2.00 $30,000 $5.70 $30,000 $16.80 $15,000 $3.00 $40,000 $7.60 $40,000 $22.40 $20,000 $4.00 $50,000 $9.50 $50,000 $28.00 $25,000 $5.00 $60,000 $11.40 $70,000 $13.30 $80,000 $15.20 $90,000 $17.10 $100,000 $19.00 $150,000 $28.50 $200,000 $38.00 $250,000 $47.50 Optional Employee Coverage Tenthly Deduction 10 pay periods Optional Spouse Coverage Tenthly Deduction Optional Child Coverage Tenthly Deduction $10,000 $2.28 $10,000 $6.72 $5,000 $1.20 $20,000 $4.56 $20, $10,000 $2.40 $30,000 $6.84 $30,000 $20.16 $15,000 $3.60 $40,000 $9.12 $40,000 $26.88 $20,000 $4.80 $50,000 $11.40 $50,000 $33.60 $25,000 $6.00 $60,000 $13.68 $70,000 $15.96 $80,000 $18.24 $90,000 $20.52 $100,000 $22.80 $150,000 $34.20 $200,000 $45.60 $250,000 $57.00 Page 72

73 Optional Employee Coverage 20 Pay Deduction 20 pay periods Optional Spouse Coverage 20 Pay Deduction Optional Child Coverage 20 Pay Deduction $10,000 $1.14 $10,000 $3.36 $5,000 $.60 $20,000 $2.28 $20,000 $6.72 $10,000 $1.20 $30,000 $3.42 $30,000 $10.08 $15,000 $1.80 $40,000 $4.56 $40,000 $13.44 $20,000 $2.40 $50,000 $5.70 $50,000 $16.80 $25,000 $3.00 $60,000 $6.84 $70,000 $7.98 $80,000 $9.12 $90,000 $10.26 $100,000 $11.40 $150,000 $17.10 $200,000 $22.80 $250,000 $28.50 Optional Employee Coverage 24 Pay Deduction 24 pay periods Optional Spouse Coverage 24 Pay Deduction Optional Child Coverage 24 Pay Deduction $10,000 $.95 $10,000 $2.80 $5,000 $.50 $20,000 $1.90 $20,000 $5.60 $10,000 $1.00 $30,000 $2.85 $30,000 $8.40 $15,000 $1.50 $40,000 $3.80 $40,000 $11.20 $20,000 $2.00 $50,000 $4.75 $50,000 $14.00 $25,000 $2.50 $60,000 $5.70 $70,000 $6.65 $80,000 $7.60 $90,000 $8.55 $100,000 $9.50 $150,000 $14.25 $200,000 $19.00 $250,000 $23.75 Page 73

74 Texas Life Whole Life Insurance Plan Common Issue Date for payroll purposes: October 1, 2012 Coverage is afforded when application is completed (pending underwriting approval when applicable). This Voluntary Permanent Life Program will allow you to purchase permanent life insurance for you and your eligible dependents. VPL- plus is an individual permanent life insurance product specifi cally designed for employees and their families. It provides a guaranteed level premium and death benefi t for the life of the policy, and you can keep the life insurance even after you retire. 1 As an employee, you are eligible to apply if you have satisfi ed your employer s eligibility period. You may also apply for coverage on your spouse, children and grandchildren. 2 WHY VOLUNTARY COVERAGE Most employees are typically dependent on group term life insurance Today more adults than ever have only group life insurance obtained through their employers, but they carry the lowest average amount of coverage. 3 On the other hand, adults with both individual life and group life policies have the highest life insurance protection. 3 Most term policies generally expire before paying a death claim When do you want a life insurance policy in force? Answer: When you die Term is for IF you die; permanent is for WHEN you die TEXAS LIFE S VPL-plus Portable, permanent life insurance through the convenience of payroll deduction Whole life chassis Strong guarantees Popular features Coverage available for spouse, minor children and grandchildren 2 VPL-plus: PORTABLE AND PERMANENT Employee can keep policy, at same premium, if he/she retires or changes jobs Employee may apply for spouse, children and grandchildren at the worksite 2 Permanent coverage: policy guaranteed to remain in force as long as necessary premiums are paid VPL-plus: THE GUARANTEES EMPLOYEES WANT Guaranteed level premium Guaranteed level death benefi t 1 Guaranteed reduced paid-up insurance at retirement Guaranteed paid-up for face amount at age 70 (or after 20 years for insureds between ages 51 and 70) 10MI63-C1111(EXP 10/12) R0212 See the VPL: -plus brochure for complete details - Form PWLESV-NI-05 Page 74

75 VPL-plus: CGI (EXPRESS ISSUE) UNDERWRITING Employee, spouse coverage require 3 health and employment related questions: During the last six months, has the proposed insured been actively at work on a full-time basis, performing usual duties? During the last six months, has the proposed insured been absent from work due to illness or medical treatment for a period of more than fi ve consecutive working days? During the last six months, has the proposed insured been disabled or received tests, treatment or care of any kind in a hospital or nursing home or received chemotherapy, hormonal therapy for cancer, radiation therapy, dialysis treatment or treatment for alcohol or drug abuse? Child coverage (ages 6 months -26 years old) 2 : During the last six months, has the proposed insured been disabled or received tests, treatment or care of any kind in a hospital or nursing home or received chemotherapy, hormonal therapy for cancer, radiation therapy, dialysis treatment or treatment for alcohol or drug abuse? Express Issue Maximums employee ages 17-49, $100,000 ages 50-65, $50,000 ages 66-70, $10,000 spouse (if employee applies) ages 17-49, $50,000 ages 50-65, $25,000 ages 66-70, $10,000 spouse (if employee does not apply) ages $25,000 ages $20,000 ages $15,000 ages $10,000 ages $7,500 ages $5,000 children - ages 6 months -26 years $25,000 2 grandchildren - ages 6 months -16 years $25,000 2 Simplified Issue 4 Use if proposed insured wants amounts over Express Issue maximums Coverage is dependent on answers to health-related and other questions contained in the application Answer all underwriting questions Blood required for amounts in excess of $100,000 Rates are unisex Rates are unismoke Page 75

76 Accelerated Death Rider Included on all policies (Employee, Spouse, Minor Children, Grandchildren) 2 Pays 92% of death benefi t, (84% for Illinois) less $150 processing fee, upon physician certifi ed diagnosis of condition expected to result in death within 12 months (24 months in IL) (conditions and limitations apply) No extra charge for rider Policy terminates when rider is exercised Waiver of Premium Available for issue ages Benefi t payable to insured through age 60 Cost is included in premium VPL-plus: Review Permanent and portable when you change jobs or retire Non-participating Whole Life chassis (no dividends) Guaranteed level death benefi t 1 Guaranteed level premium Guaranteed reduced paid-up insurance at retirement Premiums cease at age 70 (or after 20 years, ages 51-70) Accelerated Death Benefi t Rider included on all policies Waiver of Premium available issue ages Express Issue underwriting Unisex rates Unismoke rates Blood required for amounts over $100,000 Simplifi ed issue for health reasons or for amounts over Express Issue maximums 1 Guarantees are backed by the claims paying ability and fi nancially strength of the issuing company. 2 Policies not available on children & grandchildren in WA. 3 Generations at Risk LIMRA International (2008) 4 We retain the right to require a medical exam. This brochure has been prepared to give you the highlights of coverage now being offered through your employer to meet your insurance needs. The details will be provided during your individual meeting with a qualifi ed Texas Life Enrollment Representative. Those employees who wish to participate will be provided a personal policy that spells out all policy provisions. If you have any questions regarding your Texas Life policy, please call prompt #3. Page 76

77 Liberty Mutual Auto & Homeowners Insurance Plan Employee benefi ts now include savings on auto and home insurance! Cabarrus County Schools has teamed up with Liberty Mutual to offer our employees Group Savings Plus. This unique program allows you to purchase high-quality auto, home, and renters insurance at low group rates through the convenience of bank draft. Liberty Guard Auto Insurance Liberty Guard Auto Insurance provides coverage from collision to theft, and includes extra benefi ts to help make insurance easier for you. Here is a brief list of some of the coverages that come with a Liberty Guard Auto Insurance policy. Liability coverage If you cause an accident, your policy will pay the damages up to your policy limits. We will pay the legal expenses if a suit is brought against you. Medical payments coverage In some states, Medical Payments Coverage is required, and is included in your policy. In other states, you may choose to purchase Medical Payments Coverage at an additional cost. This coverage covers anyone injured in your vehicle for reasonable medical and funeral expenses for up to three years after the accident. Uninsured motorist coverage In some states, Uninsured Motorist Coverage is required, and is included in your policy. In other states, you may choose to purchase Uninsured Motorist Coverage at an additional cost. If you are in an accident with someone who does not have enough, or any, insurance, this coverage will protect you up to your policy limits. You can purchase coverage for damage to your auto that best fits your needs Collision coverage provides protection if your car rolls over, is hit by another car, or hits another car or object Other Than Collision coverage protects your car when it is damaged by other perils, such as birds, animals, fire, theft, vandalism, windstorm, earthquake, and hail. Towing and Labor coverage provides for towing each time you need it. LibertyGuard Deluxe Homeowners Insurance Your home is not only one of the largest investments you ll ever make, it is also one of the most important assets you and your family have. You need to feel secure about your home and its contents, and that starts with the right insurance coverage. Page 77

78 A Liberty Mutual LibertyGuard Deluxe Homeowners Insurance policy protects your home and other structures on your premises against direct physical loss on your premises. We ll protect your belongings if they are damaged or stolen, and we ll even protect your pets against claims for accidental bodily injury or property damage. Think you need to live near water to need fl ood insurance? Think again. Floods can be caused by storms, hurricanes and even melting snow. Don t get caught in rising water protect your home with fl ood insurance. Flood insurance is provided by Liberty Mutual authorized by the Federal Emergency Management Agency for over 18,000 participating communities. Flood coverage must be purchased as a separate policy as fl ood damage is not covered under homeowner policies. LibertyGuard Tenants Insurance Insurance is not just for homeowners. If you rent your home, you should consider protecting your possessions with a LibertyGuard Tenants Insurance policy. It covers you for items such as computer equipment, jewelry, stereo equipment, furniture, and clothing if these belongings are stolen or damaged, whether they are at home or anywhere in the world. You will also have protection against claims for accidental bodily injury or property damage, at or away from your home. Watercraft Insurance can be added to your Tenants policy as well as many other endorsements for an additional cost. LibertyGuard Condominium Insurance Your condominium is more than a place to live; it is a home fi lled with memories and your valuable possessions. Should you ever suffer a loss due to fi re, robbery, or other circumstances, you want to be sure your belongings are protected. Liberty Mutual s LibertyGuard Condominium Insurance will provide you with the coverage you need. The LibertyGuard Condominium policy also provides coverage for the alterations, appliances, fi xtures and improvements which are part of your unit. See for yourself how much money you could save with Liberty Mutual compared to your current insurance provider. For a free, no-obligation quote, please call or visit *Group discounts, other discounts, and credits are available where state laws and regulations allow, and may vary by state. Certain discounts apply to specifi c coverages only. To the extent permitted by law, applicants are individually underwritten; not all applicants may qualify. Coverage provided and underwritten by Liberty Mutual Insurance Company and its affi liates, 175 Berkeley Street, Boston, MA. Page 78

79 Continuation of Benefits AFLAC PERSONAL ACCIDENT INDEMNITY PLAN When you leave employment, you may continue your Afl ac policies by having the premiums currently being deducted from your paycheck either drafted from your bank account or billed directly to your home. You may contact Aflac toll-free at ALLSTATE CANCER When you leave employment, you may continue your Allstate Cancer policy by having the premiums currently being deducted from your paycheck either drafted from your bank account or billed directly to your home. You may contact Allstate toll-free at AMERITAS DENTAL Under the Ameritas dental plan, you and your covered dependents are eligible to continue coverage through COBRA according to the qualifying events. If you and your dependents are enrolled in the dental plan, you will be eligible to continue coverage through COBRA after you leave your employment for a specified period. In addition, while covered under the plan, if you should die, become divorced or legally separated, or become eligible for Medicare, your covered dependents maybe eligible to continue dental coverage through COBRA. Also, while you are covered under the plan, your covered children who no longer qualify as an eligible dependent may continue coverage through COBRA. Examples of an ineligible dependent would be when your child graduates from college, or reaches the age of not being eligible for dependent coverage. You will receive notifi cation with premium and continuation options shortly following your termination of employment. Should you have any questions you may contact your Benefits Department at AUL SHORT TERM DISABILITY When you leave employment, you will be able to have the premium billed directly to your home. Should you have any questions you may contact AUL at COMMUNITY EYE CARE VISION Under the Community Eye Care plan, you may continue the Vision coverage once you leave employment by calling Community Eye Care and getting the deduction set up to be bank drafted or paid by Visa and or Mastercard. The premium will remain the same even though you have ceased employment. You may set up direct bill or credit card payments by contacting Community Eye Care at CONTINENTAL AMERICAN INSURANCE GROUP CRITICAL ILLNESS When you leave employment, you may continue your Group Critical Illness plan by having the premiums currently being deducted from your paycheck either drafted from your bank account or billed directly to your home. Certain stipulations apply. You may contact Continental American Insurance Company toll-free at Page 79

80 FLEXIBLE BENEFIT ADMINISTRATORS If you have a positive balance (payroll deductions are greater than the amount you have received in reimbursement) in your Health Care Spending Account at the time of your termination, you may continue participation in the Plan for the remainder of the Plan year. If you want to remain in the Plan, you can do so by selecting one of the COBRA options. If you prefer to terminate your participation and contribution to the Plan, any balance in your account on the date of termination will be forfeited if expenses were not incurred prior to the date of termination. For more detailed information, please call your Benefits Department at or Flexible Benefit Administrators at LINCOLN FINANCIAL TERM LIFE Conversion: You must apply and pay the premium for the converted policy within 31 days of your group life insurance ending. If the policy ends or is changed to reduce or end your life insurance, and if you have been insured for at least 5 years under the policy, you may convert up to the lesser of: $10,000 or the amount of life insurance that ended minus the amount of any group life insurance for which you become eligible within 31 days. Please contact your Human Resources Department at for more information. LIBERTY MUTUAL AUTO & HOMEOWNERS When you leave employment, you may continue the coverage that you have with Liberty Mutual. The coverage will continue to be drafted from your bank account. If you have questions you may contact Liberty Mutual at TEXAS LIFE WHOLE LIFE When you leave employment, you may continue your Texas Life Whole Life coverage by having the premiums that are currently deducted from your paycheck drafted from your bank account. You may do that by contacting Texas Life at prompt #3. Page 80

81 PHONE DIRECTORY Afl ac Personal Accident Indemnity Plan or en español: Allstate Workplace Cancer Plan Ameritas Dental Plan AUL Short Term Disability Plan Cabarrus County Schools Human Resources Community Eye Care Vision Plan Continental American Insurance Company Group Critical Illness Plan Flexible Benefi t Administrators Spending Accounts Investment & Retirement Accounts Liberty Mutual Auto & HomeOwners Plan Lincoln Financial Term Life Plan Mark III Brokerage, Inc Texas Life Whole Life Plan prompt #3. Page 81